1225012818 NPI number — DR. ROBERT LESLIE BURNS O.D.

Table of content: DR. ROBERT LESLIE BURNS O.D. (NPI 1225012818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225012818 NPI number — DR. ROBERT LESLIE BURNS O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURNS
Provider First Name:
ROBERT
Provider Middle Name:
LESLIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225012818
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
149 WALNUT ST
Provider Second Line Business Mailing Address:
PO BOX 18
Provider Business Mailing Address City Name:
REEDSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17084-0018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-667-6473
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
54 CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17044-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-248-4574
Provider Business Practice Location Address Fax Number:
717-248-3937
Provider Enumeration Date:
12/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000614 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OEG000614 . This is a "STATE OPTOMETRIC LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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