Provider Demographics
NPI:1609837954
Name:BOYD, SANDRA L (OD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:L
Last Name:BOYD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 RUE DE YOE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1355
Mailing Address - Country:US
Mailing Address - Phone:209-526-8638
Mailing Address - Fax:209-526-8638
Practice Address - Street 1:131 RUE DE YOE
Practice Address - Street 2:SUITE B
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1355
Practice Address - Country:US
Practice Address - Phone:209-526-8638
Practice Address - Fax:209-526-8638
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5244T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0052440Medicaid
CASD0052440Medicaid
CASD0052440Medicare ID - Type UnspecifiedMEDICARE EXAM
CA0835630001Medicare NSC