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Larry Bolyard
NPI 1538412531 · on the registry since 2012
Practice
- Address
- 1205 Hickory Point Mall
Forsyth, IL 62535 - Phone
- (217) 877-7133
- Organisation at this address
- Luxottica Retail North America Inc
Inferred from a shared address, not stated in the registry.
Registry record
- Primary taxonomy
- 237700000X
237700000X
- Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2012-10-16
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois