Provider Demographics
NPI:1043278716
Name:BURTON, BRIAN MICHAEL (LDO)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:BURTON
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 CRIMSON LEAF LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:SC
Mailing Address - Zip Code:29657-4202
Mailing Address - Country:US
Mailing Address - Phone:864-506-6256
Mailing Address - Fax:864-639-4012
Practice Address - Street 1:134 CRIMSON LEAF LN
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:SC
Practice Address - Zip Code:29657-4202
Practice Address - Country:US
Practice Address - Phone:864-506-6256
Practice Address - Fax:864-639-4012
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC242156FC0800X
SC776156FX1800X
OH6004156FX1800X
HI260156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDV7760Medicaid