Provider Demographics
NPI:1730297185
Name:BURNS-LEGROS, DENISE (OD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:BURNS-LEGROS
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 1:2420 S BABCOCK ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5356
Mailing Address - Country:US
Mailing Address - Phone:321-725-4755
Mailing Address - Fax:321-725-5088
Practice Address - Street 1:2420 S BABCOCK ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5356
Practice Address - Country:US
Practice Address - Phone:321-725-4755
Practice Address - Fax:321-725-5088
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4006152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38200OtherBCBS
FL10003OtherBCBS
FL38200AOtherBCBS
FL621109700Medicaid
FLP00628284OtherRR MEDICARE
FLU7262VMedicare PIN
FL1273940002Medicare NSC
FLU7262WMedicare PIN
FL10003OtherBCBS
FL1273940001Medicare NSC