Provider Demographics
NPI:1891159356
Name:BURTNER, JUSTIN (OD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:BURTNER
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 1:5528 US HIGHWAY 98 N
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-3104
Mailing Address - Country:US
Mailing Address - Phone:863-853-2020
Mailing Address - Fax:863-577-2008
Practice Address - Street 1:5528 US HIGHWAY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-3104
Practice Address - Country:US
Practice Address - Phone:863-853-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2102152W00000X
FLOPC5629152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist