Provider Demographics
NPI:1326152257
Name:BURNS, ALBERT CHARLES JR (OD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:CHARLES
Last Name:BURNS
Suffix:JR
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:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294-0156
Mailing Address - Country:US
Mailing Address - Phone:318-512-4041
Mailing Address - Fax:
Practice Address - Street 1:3360 FRONT ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-6487
Practice Address - Country:US
Practice Address - Phone:318-435-9139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA882-266T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1354392Medicaid
LA47626Medicare ID - Type Unspecified
LA1354392Medicaid