Provider Demographics
NPI:1336110808
Name:BURLINGAME, JAY JEFFREY (OD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:JEFFREY
Last Name:BURLINGAME
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 1:11500 W 119TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2002
Mailing Address - Country:US
Mailing Address - Phone:913-451-0001
Mailing Address - Fax:913-451-1659
Practice Address - Street 1:11500 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2002
Practice Address - Country:US
Practice Address - Phone:913-451-0001
Practice Address - Fax:913-451-1659
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12753152WC0802X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1336110808Medicare NSC
T71347Medicare UPIN
KSD390587Medicare PIN