Provider Demographics
NPI:1851477731
Name:BURNETT, MARTHA DENISE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:DENISE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MARTHA
Other - Middle Name:DENISE
Other - Last Name:BURNETT-COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:8865 FREEMARK WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-3003
Mailing Address - Country:US
Mailing Address - Phone:916-813-2714
Mailing Address - Fax:
Practice Address - Street 1:7300 WYNDAM DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-3003
Practice Address - Country:US
Practice Address - Phone:916-525-6421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8411T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist