Provider Demographics
NPI:1326290461
Name:BURLINGTON FAMILY EYECARE PC
Entity Type:Organization
Organization Name:BURLINGTON FAMILY EYECARE PC
Other - Org Name:MICHAEL E. BUSH, OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-752-1400
Mailing Address - Street 1:3017 WEST AVE.
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601
Mailing Address - Country:US
Mailing Address - Phone:319-752-1400
Mailing Address - Fax:319-752-1401
Practice Address - Street 1:3017 WEST AVE.
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601
Practice Address - Country:US
Practice Address - Phone:319-752-1400
Practice Address - Fax:319-752-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02028152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU53345Medicare UPIN
IA6170930001Medicare NSC