Provider Demographics
NPI:1821155466
Name:THOMAS-BURKE, GILLIAN A (OD)
Entity Type:Individual
Prefix:DR
First Name:GILLIAN
Middle Name:A
Last Name:THOMAS-BURKE
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 1:12640 N. KENDALL DR.
Mailing Address - Street 2:
Mailing Address - City:KENDALL
Mailing Address - State:FL
Mailing Address - Zip Code:33186
Mailing Address - Country:US
Mailing Address - Phone:305-273-7790
Mailing Address - Fax:305-273-8018
Practice Address - Street 1:12640 N. KENDALL DR.
Practice Address - Street 2:
Practice Address - City:KENDALL
Practice Address - State:FL
Practice Address - Zip Code:33186
Practice Address - Country:US
Practice Address - Phone:305-273-7790
Practice Address - Fax:305-273-8018
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2817152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist