Provider Demographics
NPI:1881907517
Name:BURGERS, KYLE DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:DAVID
Last Name:BURGERS
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 1:310 N DESPLAINES ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2003
Mailing Address - Country:US
Mailing Address - Phone:616-304-5106
Mailing Address - Fax:
Practice Address - Street 1:939 W NORTH AVE STE 220
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-8684
Practice Address - Country:US
Practice Address - Phone:312-664-3937
Practice Address - Fax:312-664-6383
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010352152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist