Provider Demographics
NPI:1770899536
Name:BURCHAM, MARC A (OD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:BURCHAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11700 PRINCETON PIKE
Mailing Address - Street 2:LENSCRAFTERS
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2535
Mailing Address - Country:US
Mailing Address - Phone:513-671-5020
Mailing Address - Fax:
Practice Address - Street 1:265 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4806
Practice Address - Country:US
Practice Address - Phone:330-726-6302
Practice Address - Fax:330-726-0025
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist