Provider Demographics
NPI:1114958360
Name:GATTEN, ERNEST BURDETTE (OD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:BURDETTE
Last Name:GATTEN
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 1:100 BAILEY DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-2427
Mailing Address - Country:US
Mailing Address - Phone:757-562-6101
Mailing Address - Fax:757-562-4244
Practice Address - Street 1:100 BAILEY DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-2427
Practice Address - Country:US
Practice Address - Phone:757-562-6101
Practice Address - Fax:757-562-4244
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000051152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9232265Medicaid
VA9232265Medicaid