Provider Demographics
NPI:1790919934
Name:BURD, MIKHAIL (OD)
Entity Type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:
Last Name:BURD
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 1:1544 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3561
Mailing Address - Country:US
Mailing Address - Phone:718-382-9790
Mailing Address - Fax:
Practice Address - Street 1:1544 W 1ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3561
Practice Address - Country:US
Practice Address - Phone:718-382-9790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-02
Last Update Date:2016-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician