Provider Demographics
NPI:1093015596
Name:BURNETT, ERIK NATHANAEL (OD)
Entity Type:Individual
Prefix:MR
First Name:ERIK
Middle Name:NATHANAEL
Last Name:BURNETT
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 1:4730 E PIMA ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3521
Mailing Address - Country:US
Mailing Address - Phone:520-795-3956
Mailing Address - Fax:520-318-3431
Practice Address - Street 1:4730 E PIMA ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3521
Practice Address - Country:US
Practice Address - Phone:520-795-3956
Practice Address - Fax:520-318-3431
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-30
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1998152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management