Provider Demographics
NPI:1669651808
Name:DAVID B. BURNETT P.C.
Entity Type:Organization
Organization Name:DAVID B. BURNETT P.C.
Other - Org Name:OAKRIDGE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BOYLE
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-447-4393
Mailing Address - Street 1:174 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-3625
Mailing Address - Country:US
Mailing Address - Phone:801-447-4393
Mailing Address - Fax:801-447-8744
Practice Address - Street 1:57 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3517
Practice Address - Country:US
Practice Address - Phone:801-447-4393
Practice Address - Fax:801-447-8744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5676092-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT00564302Medicare PIN
UT0058013Medicare Oscar/Certification