Provider Demographics
NPI:1962827402
Name:BURKE, SELENE (OD)
Entity Type:Individual
Prefix:DR
First Name:SELENE
Middle Name:
Last Name:BURKE
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 1:3425 NAVARRO WAY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-2133
Mailing Address - Country:US
Mailing Address - Phone:972-896-1653
Mailing Address - Fax:
Practice Address - Street 1:9155 STERLING ST STE 160
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2430
Practice Address - Country:US
Practice Address - Phone:972-896-1653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS752152W00000X
TN2702152W00000X
TX06826TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist