Provider Demographics
NPI:1336135003
Name:BURRELL, KERRY JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:JAMES
Last Name:BURRELL
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 1:50 BERKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1219
Mailing Address - Country:US
Mailing Address - Phone:610-374-3134
Mailing Address - Fax:
Practice Address - Street 1:50 BERKSHIRE COURT
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1219
Practice Address - Country:US
Practice Address - Phone:610-374-3134
Practice Address - Fax:610-374-0484
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001239152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA109527OtherGEISINGER
PA50065146OtherCAPITAL BLUE CROSS/POS/PPO/TRADITIONAL
PANON PAROtherDAVIS VISION
PAOEG001239OtherCORESOURCE
PAP00398062OtherMEDICARE RAILROAD
PA1727232OtherHIGHMARK/BLUE SHIELD
PA2165780OtherUNITED HEALTHCARE
PA29435/29436OtherSPECTERA
PA50065146OtherKEYSTONE SENIOR BLUE
PA1336135003OtherVSP/VISION SERVICE PLAN
PA1727232OtherHIGHMARK/CLASSIC/PPO/PPO BLUE
PA2206957OtherSECURE HORIZON
PA2396184000OtherINDEPENDENCE BC/BS
PA2396184000OtherKEYSTONE EAST
PA7564837OtherAETNA
PAPA12390OtherVBA/VISION BENEFITS OF AMERICA
PA2396184000OtherAMERIHEALTH
PA7564837OtherAETNA TRADITIONAL/PPO
PA7564837OtherAETNA/HMO
PA9101041OtherCIGNA
PAORG001239OtherDEVON
PA50065146OtherKEYSTONE/CBC
PA532616OtherHEALTHAMERICA/HEALTH ASSURANCE
PAOEG001239OtherLOOMIS
PA2396184000OtherINDEPENDENCE PERSONAL CHOICE
PA50065146OtherCAPITAL BLUE CROSS/SB/SB PPO/HMO
PA54384001OtherDAVIS AFFINITY
PANON PAROtherNVA
PAOEG001239OtherHUMANA
PA50065146OtherCAPITAL BLUE CROSS
PA50065146OtherCAPITAL BLUE CROSS/KHPC
PAOEG001239OtherBERKSHIRE HEALTH PARTNERS
PA29435/29436OtherSPECTERA
PA50065146OtherKEYSTONE/CBC
PAOEG001239OtherHUMANA