Provider Demographics
NPI:1326106733
Name:BURKHART, ANDREW MCKAY (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MCKAY
Last Name:BURKHART
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 1:511 W LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3481
Mailing Address - Country:US
Mailing Address - Phone:765-453-2907
Mailing Address - Fax:765-453-6111
Practice Address - Street 1:511 W LINCOLN RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3481
Practice Address - Country:US
Practice Address - Phone:765-453-2907
Practice Address - Fax:765-453-6111
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002874152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200177240-BMedicaid
U67870Medicare UPIN
0167790001Medicare NSC
632110-EMedicare ID - Type Unspecified