1740389519 NPI number — DR. ROBERT P BURROWS O.D.

Table of content: DR. ROBERT P BURROWS O.D. (NPI 1740389519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740389519 NPI number — DR. ROBERT P BURROWS O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURROWS
Provider First Name:
ROBERT
Provider Middle Name:
P
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:
1740389519
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1126
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEHALIS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98532-0169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-748-9228
Provider Business Mailing Address Fax Number:
360-748-4617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1179 S MARKET BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEHALIS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98532-3427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-748-9228
Provider Business Practice Location Address Fax Number:
360-748-4617
Provider Enumeration Date:
09/21/2006

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:  OD00001416 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 00001416 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WC0802X , with the licence number: OD00001416 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2030237 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0036580 . This is a "L&I CLINIC GROUP NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0052484 . This is a "L&I RPBURROWS ONLY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2046506 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: BU0836 . This is a "REGENCE RPBURROWS ONLY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: HE7836 . This is a "REGENCE CLINIC NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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