Provider Demographics
NPI:1801940895
Name:BURKE, ZANE GREY (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:ZANE
Middle Name:GREY
Last Name:BURKE
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:RT.209
Mailing Address - City:GILBERT
Mailing Address - State:PA
Mailing Address - Zip Code:18331-0067
Mailing Address - Country:US
Mailing Address - Phone:610-681-6116
Mailing Address - Fax:610-681-6128
Practice Address - Street 1:BRODHEADSVILLE EYE CARE CENTER
Practice Address - Street 2:BOX 67 AMES PLAZA
Practice Address - City:GILBERT
Practice Address - State:PA
Practice Address - Zip Code:18331
Practice Address - Country:US
Practice Address - Phone:610-681-6116
Practice Address - Fax:610-681-6128
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician