Provider Demographics
NPI:1437157690
Name:BURGES, WILLIAM R (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:BURGES
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 1:405 PARIS ST
Mailing Address - Street 2:
Mailing Address - City:CASTROVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78009-4511
Mailing Address - Country:US
Mailing Address - Phone:830-538-2241
Mailing Address - Fax:830-931-3453
Practice Address - Street 1:405 PARIS ST
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:TX
Practice Address - Zip Code:78009-4511
Practice Address - Country:US
Practice Address - Phone:830-538-2241
Practice Address - Fax:830-931-3453
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2357TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0932998-02Medicaid
TX0932998-02Medicaid
TXT12468Medicare UPIN