Provider Demographics
NPI:1598759383
Name:BURDICK, EDMUND W (OD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:W
Last Name:BURDICK
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:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18834-0423
Mailing Address - Country:US
Mailing Address - Phone:570-465-3188
Mailing Address - Fax:570-465-3187
Practice Address - Street 1:188 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18834-2104
Practice Address - Country:US
Practice Address - Phone:570-465-3188
Practice Address - Fax:570-465-3187
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000478152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABU288641Medicare ID - Type Unspecified
PAU08065Medicare UPIN
PA0124830001Medicare NSC