Provider Demographics
NPI:1972620011
Name:BOYLAND, MIA S I (OD)
Entity type:Individual
Prefix:DR
First Name:MIA
Middle Name:S
Last Name:BOYLAND
Suffix:I
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MIA
Other - Middle Name:S
Other - Last Name:BOYLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 723
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-0723
Mailing Address - Country:US
Mailing Address - Phone:901-744-0888
Mailing Address - Fax:901-744-0888
Practice Address - Street 1:2389 LAMAR AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38114-3709
Practice Address - Country:US
Practice Address - Phone:901-744-0888
Practice Address - Fax:901-744-0888
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1871152W00000X
MS670152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU84849Medicare UPIN
TN3944260Medicare Oscar/Certification