Provider Demographics
NPI:1346419157
Name:ROGER L. BURCH, O.D.
Entity Type:Organization
Organization Name:ROGER L. BURCH, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-879-2020
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:CANEY
Mailing Address - State:KS
Mailing Address - Zip Code:67333-0039
Mailing Address - Country:US
Mailing Address - Phone:620-879-2020
Mailing Address - Fax:620-879-5381
Practice Address - Street 1:124 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:CANEY
Practice Address - State:KS
Practice Address - Zip Code:67333-1460
Practice Address - Country:US
Practice Address - Phone:620-879-2020
Practice Address - Fax:620-879-5381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0309440001Medicare NSC