Provider Demographics
NPI:1639941099
Name:BURNS, CLARISSA NICOLE (OD)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:NICOLE
Last Name:BURNS
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:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45012-0837
Mailing Address - Country:US
Mailing Address - Phone:513-454-1111
Mailing Address - Fax:513-737-1592
Practice Address - Street 1:250 N FAIR AVE STE B
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-4222
Practice Address - Country:US
Practice Address - Phone:513-454-1111
Practice Address - Fax:513-737-1592
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.007223152W00000X
KY2363DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist