Provider Demographics
NPI:1831261148
Name:LAN F BURCH
Entity type:Organization
Organization Name:LAN F BURCH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:870-732-4701
Mailing Address - Street 1:201 S AVALON ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-4172
Mailing Address - Country:US
Mailing Address - Phone:870-732-4701
Mailing Address - Fax:870-732-5400
Practice Address - Street 1:201 SOUTH AVALON ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4172
Practice Address - Country:US
Practice Address - Phone:870-732-4701
Practice Address - Fax:870-732-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2025152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F238OtherMEDICARE GROUP ID
AR0372520001Medicare NSC