Provider Demographics
NPI:1932211240
Name:BURDICK, RICHARD DOUGLAS (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DOUGLAS
Last Name:BURDICK
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 1:6867 WINTER KING DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-8756
Mailing Address - Country:US
Mailing Address - Phone:317-539-4287
Mailing Address - Fax:
Practice Address - Street 1:9500 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7366
Practice Address - Country:US
Practice Address - Phone:317-209-8429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001842B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
142120Medicare ID - Type Unspecified
U76587Medicare UPIN