Provider Demographics
NPI:1205064615
Name:BURD, ALISON MARY (OD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:MARY
Last Name:BURD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:MARY
Other - Last Name:MOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:845 CIMARRON CIR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-2157
Mailing Address - Country:US
Mailing Address - Phone:573-454-2940
Mailing Address - Fax:573-454-2942
Practice Address - Street 1:407 N STATE ST
Practice Address - Street 2:
Practice Address - City:DESLOGE
Practice Address - State:MO
Practice Address - Zip Code:63601-3053
Practice Address - Country:US
Practice Address - Phone:573-431-2974
Practice Address - Fax:573-431-3170
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009016902152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO319346102Medicaid
MO4637030003Medicare NSC
MO4637030002Medicare NSC
MO168600002Medicare PIN
MO319346102Medicaid
MOP00790927Medicare PIN
MO4637030001Medicare NSC