Provider Demographics
NPI:1154774693
Name:BOATMAN, ASHLEY (OD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BOATMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:MARVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:5 ILLINI DR
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-3927
Mailing Address - Country:US
Mailing Address - Phone:618-659-7341
Mailing Address - Fax:618-692-7887
Practice Address - Street 1:5 ILLINI DR
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-3927
Practice Address - Country:US
Practice Address - Phone:618-659-7341
Practice Address - Fax:618-692-7887
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016025832152W00000X
IL046011046152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist