Provider Demographics
NPI:1942202064
Name:BURRUSS, SHARON SAUM (OD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:SAUM
Last Name:BURRUSS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:MARIE
Other - Last Name:SAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1241 E WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901
Mailing Address - Country:US
Mailing Address - Phone:618-529-3452
Mailing Address - Fax:
Practice Address - Street 1:1241 E WALNUT
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901
Practice Address - Country:US
Practice Address - Phone:618-529-3452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009628152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U7440Medicare UPIN