Provider Demographics
NPI:1245057629
Name:BURDICK, GARY
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:BURDICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 BRANDT POINT DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-1986
Mailing Address - Country:US
Mailing Address - Phone:585-787-1810
Mailing Address - Fax:585-670-9932
Practice Address - Street 1:1990 BRANDT POINT DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1986
Practice Address - Country:US
Practice Address - Phone:585-787-1810
Practice Address - Fax:585-670-9932
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010493-01156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician