Provider Demographics
NPI:1699807784
Name:BURGE, EMERSON LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:EMERSON
Middle Name:LYNN
Last Name:BURGE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 E WHIDBEY AVE
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-2573
Mailing Address - Country:US
Mailing Address - Phone:360-675-2295
Mailing Address - Fax:
Practice Address - Street 1:390 E WHIDBEY AVE
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-2573
Practice Address - Country:US
Practice Address - Phone:360-675-2295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATX 1120152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABURGG 23760OtherSKAGIT COUNTY MEDICAL BUR
WA061044001OtherGROUP HEALTH
WA2012102Medicaid
WAT02897Medicare UPIN
WA061044001OtherGROUP HEALTH