Provider Demographics
NPI:1912073511
Name:BURKE, RALESHIA NIX (OD)
Entity Type:Individual
Prefix:DR
First Name:RALESHIA
Middle Name:NIX
Last Name:BURKE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:RALESHIA
Other - Middle Name:LANISE
Other - Last Name:NIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2320 COLEMAN RD
Mailing Address - Street 2:APARTMENT 207 C
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-6870
Mailing Address - Country:US
Mailing Address - Phone:256-835-6896
Mailing Address - Fax:
Practice Address - Street 1:92 PLAZA LN
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-2440
Practice Address - Country:US
Practice Address - Phone:256-835-4806
Practice Address - Fax:256-835-4988
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-911 TA-478152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51531919OtherBCBS PROVIDER NUMBER
AL51531919OtherBCBS PROVIDER NUMBER