Provider Demographics
NPI:1124009824
Name:BURESH, KARRI A (OD)
Entity Type:Individual
Prefix:MRS
First Name:KARRI
Middle Name:A
Last Name:BURESH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E 300 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2418
Mailing Address - Country:US
Mailing Address - Phone:801-322-0467
Mailing Address - Fax:801-363-6053
Practice Address - Street 1:250 E 300 S
Practice Address - Street 2:BERNER EYE CLINIC
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2418
Practice Address - Country:US
Practice Address - Phone:801-322-0467
Practice Address - Fax:801-363-6053
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT53506379931152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U97152Medicare UPIN
UT005528701Medicare ID - Type Unspecified