Provider Demographics
NPI:1760526628
Name:BURDEN, BRENDA LYNN (OD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LYNN
Last Name:BURDEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:DEARMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:14050 JUANITA DR NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-9708
Mailing Address - Country:US
Mailing Address - Phone:425-820-2020
Mailing Address - Fax:425-821-9576
Practice Address - Street 1:14050 JUANITA DR NE
Practice Address - Street 2:SUITE A
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-9708
Practice Address - Country:US
Practice Address - Phone:425-820-2020
Practice Address - Fax:425-821-9576
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATX3126152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8881012OtherMEDICARE INDIVIDUAL PTAN
WAP00792547OtherRAILROAD MEDICARE INDIVIDUAL
WA11719788OtherCAQH PERSONAL ID#
WA1760526628OtherNPI PERSONAL
WA2021087Medicaid
WA1831822OtherCHPW INDIVIDUAL ID#
WAMB1191179OtherDEA NUMBER
WAMB1191179OtherDEA NUMBER