Basic Information
| Provider Information | |||||||||
| NPI: | 1659425585 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | KENNETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OPTOMETRIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6926 NUMBER FIVE RD | ||||||||
| Address2: | |||||||||
| City: | PLEASANT PLAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451629619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136251872 | ||||||||
| FaxNumber: | 0000000000 | ||||||||
| Practice Location | |||||||||
| Address1: | 4621 EASTGATE BLVD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452451203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137538172 | ||||||||
| FaxNumber: | 5137525831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 3927 | OH | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.