Provider Demographics
NPI:1649369463
Name:MARTIN, BURKE DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:BURKE
Middle Name:DAVID
Last Name:MARTIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 ARRONIMINK CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6303
Mailing Address - Country:US
Mailing Address - Phone:512-785-0632
Mailing Address - Fax:
Practice Address - Street 1:2701 S I H 35
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7320
Practice Address - Country:US
Practice Address - Phone:512-388-2600
Practice Address - Fax:512-388-0854
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5141T152W00000X, 152WC0802X
GAOPT001505152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX19973OtherSPECTERA
TX550475OtherNATIONAL VISION ADMINISTRATORS
TX13860OtherAVESIS
TX920531OtherBLOCK (CHIP & AMERIGROUP)
49292OtherDAVIS
TX019327801Medicaid