Provider Demographics
NPI:1871512962
Name:WM R BURGES OD PA
Entity Type:Organization
Organization Name:WM R BURGES OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURGES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:830-931-2328
Mailing Address - Street 1:405 PARIS
Mailing Address - Street 2:
Mailing Address - City:CASTROVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78009-4527
Mailing Address - Country:US
Mailing Address - Phone:830-931-2328
Mailing Address - Fax:830-931-4326
Practice Address - Street 1:405 PARIS
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:TX
Practice Address - Zip Code:78009-4527
Practice Address - Country:US
Practice Address - Phone:830-931-2328
Practice Address - Fax:830-931-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2357TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT12468Medicare UPIN
TX00936UMedicare ID - Type Unspecified
TXP00018075Medicare PIN