Provider Demographics
NPI:1255454468
Name:BURKE, DAVID WATKINS (COT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WATKINS
Last Name:BURKE
Suffix:
Gender:M
Credentials:COT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3122
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28680-3122
Mailing Address - Country:US
Mailing Address - Phone:828-433-5760
Mailing Address - Fax:828-324-4271
Practice Address - Street 1:3521 GRAYSTONE PL
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-8201
Practice Address - Country:US
Practice Address - Phone:828-322-2050
Practice Address - Fax:828-324-4271
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC42218156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic