Provider Demographics
NPI:1750378055
Name:BURNS, CHRISTINE LEE (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:LEE
Last Name:BURNS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14003 LAKESHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7124
Mailing Address - Country:US
Mailing Address - Phone:727-868-9442
Mailing Address - Fax:727-862-6210
Practice Address - Street 1:14003 LAKESHORE BLVD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7124
Practice Address - Country:US
Practice Address - Phone:727-868-9442
Practice Address - Fax:727-862-6210
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-01
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 32382207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046808801Medicaid
FL046808801Medicaid
FL73277Medicare PIN