Provider Demographics
NPI:1699405795
Name:BURNS, CRYSTAL SUE
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:SUE
Last Name:BURNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 IRVIN COBB DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-2196
Mailing Address - Country:US
Mailing Address - Phone:270-444-7824
Mailing Address - Fax:270-444-9052
Practice Address - Street 1:3220 IRVIN COBB DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-0337
Practice Address - Country:US
Practice Address - Phone:270-444-7824
Practice Address - Fax:270-444-9052
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY109912156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician