Provider Demographics
NPI:1659710499
Name:BURICK, TIFFANY A (OD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:A
Last Name:BURICK
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:15066-1916
Mailing Address - Country:US
Mailing Address - Phone:724-846-4480
Mailing Address - Fax:724-846-4045
Practice Address - Street 1:903 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:PA
Practice Address - Zip Code:15066-1916
Practice Address - Country:US
Practice Address - Phone:724-846-4480
Practice Address - Fax:724-846-4045
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG02761152W00000X
OH6189152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6189OtherSTATE LICENCE