Provider Demographics
NPI:1598122574
Name:BURBANK, JOSEPHINE (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:BURBANK
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 1:9931 CARDOZA DR
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-1520
Mailing Address - Country:US
Mailing Address - Phone:253-355-2126
Mailing Address - Fax:
Practice Address - Street 1:9931 CARDOZA DR
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-1520
Practice Address - Country:US
Practice Address - Phone:253-355-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT14833TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist