Provider Demographics
NPI:1467715276
Name:BURGETT, SARAH REBECCA (OD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:REBECCA
Last Name:BURGETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 TANGLEFOOT LN
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1650
Mailing Address - Country:US
Mailing Address - Phone:563-323-2020
Mailing Address - Fax:563-328-5694
Practice Address - Street 1:4731 45TH STREET CT
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-7102
Practice Address - Country:US
Practice Address - Phone:309-793-2020
Practice Address - Fax:309-793-2602
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010509152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL977130OtherIL GROUP MEDICARE #
ILO46010509Medicaid
ILO46010509Medicaid