Provider Demographics
NPI:1821202342
Name:BURROWS VISION CLINIC LLC
Entity Type:Organization
Organization Name:BURROWS VISION CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURROWS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:308-423-2152
Mailing Address - Street 1:212 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-3515
Mailing Address - Country:US
Mailing Address - Phone:308-345-2954
Mailing Address - Fax:308-345-7719
Practice Address - Street 1:212 W 9TH ST
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3515
Practice Address - Country:US
Practice Address - Phone:308-345-2954
Practice Address - Fax:308-345-7719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE5271760001Medicare NSC