Provider Demographics
NPI:1740357375
Name:ESCHEN, BURT S (OD)
Entity type:Individual
Prefix:DR
First Name:BURT
Middle Name:S
Last Name:ESCHEN
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 1:2821 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5053
Mailing Address - Country:US
Mailing Address - Phone:718-648-0964
Mailing Address - Fax:718-616-0575
Practice Address - Street 1:2821 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5053
Practice Address - Country:US
Practice Address - Phone:718-648-0964
Practice Address - Fax:718-616-0575
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003441-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020490001Medicare ID - Type UnspecifiedGRP #
NYT71142Medicare UPIN