Provider Demographics
NPI:1518053065
Name:BURNS, ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:BURNS
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 1:1013 EAST FREEWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094
Mailing Address - Country:US
Mailing Address - Phone:770-922-7906
Mailing Address - Fax:770-483-0498
Practice Address - Street 1:1013 EAST FREEWAY DRIVE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094
Practice Address - Country:US
Practice Address - Phone:770-922-7906
Practice Address - Fax:770-483-0498
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA796152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA33529OtherAVESIS
GA0004268918OtherAETNA PPO
GA0492377OtherAETNA HMO
GA146614OtherBCBSGA
GAGA0796OtherEYEMED
GAGA0796OtherEYEMED
GAT61170Medicare UPIN