Provider Demographics
NPI:1609017854
Name:BURBANK EYECARE INC
Entity Type:Organization
Organization Name:BURBANK EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:747-261-7747
Mailing Address - Street 1:1820 W VERDUGO AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2150
Mailing Address - Country:US
Mailing Address - Phone:747-261-7747
Mailing Address - Fax:818-841-1015
Practice Address - Street 1:1820 W VERDUGO AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2150
Practice Address - Country:US
Practice Address - Phone:626-696-3607
Practice Address - Fax:626-696-3608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13140T152W00000X
152WC0802X, 156FX1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACM521AMedicare PIN
CA6445220001Medicare NSC