Provider Demographics
NPI:1083717292
Name:BURKE, ROBERT FRANKLYN (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FRANKLYN
Last Name:BURKE
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 1:1105 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-2801
Mailing Address - Country:US
Mailing Address - Phone:918-786-2254
Mailing Address - Fax:918-786-2114
Practice Address - Street 1:1105 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-2801
Practice Address - Country:US
Practice Address - Phone:918-786-2254
Practice Address - Fax:918-786-2114
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2840152W00000X
MO2007020378152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA58-2659426OtherBLUE CROSS & BLUE SHIELD
GA848144030AMedicaid
GA910276OtherCOLE MANAGED VISION
GA25093OtherSPECTERA
GA34200OtherAVESIS VISION
GAGRP7454OtherMEDICARE GROUP NUMBER
GA101061OtherAVESIS MEDICAID
GA1467849OtherCLARITY VISION
GA26950OtherMEDICAL EYE SERVICE
GA552584OtherNATIONAL VISION ADMIN.
GA48806OtherDAVIS VISION
GA552584OtherNATIONAL VISION ADMIN.
GA101061OtherAVESIS MEDICAID