Provider Demographics
NPI:1477524932
Name:BURLINGAME, CYNTHIA LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LYNN
Last Name:BURLINGAME
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 1:12616 W 121ST TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2263
Mailing Address - Country:US
Mailing Address - Phone:913-226-2123
Mailing Address - Fax:
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
KS12593152W00000X, 152WC0802X, 152WP0200X
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
KS1477524932Medicare NSC
KSD391219Medicare PIN
U08553Medicare UPIN