Provider Demographics
NPI:1295114379
Name:BURNS, VIVIANNE MARIE
Entity type:Individual
Prefix:
First Name:VIVIANNE
Middle Name:MARIE
Last Name:BURNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:D17 CALLE ZENOBIA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7610
Mailing Address - Country:US
Mailing Address - Phone:787-603-2524
Mailing Address - Fax:
Practice Address - Street 1:D17 CALLE ZENOBIA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7610
Practice Address - Country:US
Practice Address - Phone:787-603-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1243156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician