Provider Demographics
NPI:1659425585
Name:BURNS, DAVID KENNETH (OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KENNETH
Last Name:BURNS
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6926 NUMBER FIVE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PLAIN
Mailing Address - State:OH
Mailing Address - Zip Code:45162-9619
Mailing Address - Country:US
Mailing Address - Phone:513-625-1872
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:4621 EASTGATE BLVD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1203
Practice Address - Country:US
Practice Address - Phone:513-753-8172
Practice Address - Fax:513-752-5831
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3927152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
16732Medicare UPIN