Provider Demographics
NPI:1881665289
Name:BURNS, JOHN L (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:BURNS
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 1:7801 OLD BRANCH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1608
Mailing Address - Country:US
Mailing Address - Phone:301-868-9090
Mailing Address - Fax:301-868-9093
Practice Address - Street 1:7801 OLD BRANCH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1608
Practice Address - Country:US
Practice Address - Phone:301-868-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1051152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
485546E50Medicare ID - Type Unspecified
MDU42856Medicare UPIN