Provider Demographics
NPI:1053300137
Name:BURNS, EDWARD JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOHN
Last Name:BURNS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-3410
Mailing Address - Country:US
Mailing Address - Phone:617-484-8800
Mailing Address - Fax:617-489-0222
Practice Address - Street 1:291 BELMONT ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-3410
Practice Address - Country:US
Practice Address - Phone:617-484-8800
Practice Address - Fax:617-489-0222
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2424152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0332186Medicaid
T59226Medicare UPIN
MA0332186Medicaid