Provider Demographics
NPI:1932111929
Name:BURGHART, MICHELLE PEREZ (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:PEREZ
Last Name:BURGHART
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-4318
Mailing Address - Country:US
Mailing Address - Phone:305-202-4091
Mailing Address - Fax:561-844-6769
Practice Address - Street 1:408 LIGHTHOUSE DR
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-4318
Practice Address - Country:US
Practice Address - Phone:305-202-4091
Practice Address - Fax:561-844-6769
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3503152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5506Medicare ID - Type Unspecified
FLV06056Medicare UPIN