1851477731 NPI number — DR. MARTHA DENISE BURNETT O.D.

Table of content: DR. MARTHA DENISE BURNETT O.D. (NPI 1851477731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851477731 NPI number — DR. MARTHA DENISE BURNETT O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURNETT
Provider First Name:
MARTHA
Provider Middle Name:
DENISE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURNETT-COLLINS
Provider Other First Name:
MARTHA
Provider Other Middle Name:
DENISE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1851477731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9751 KAPALUA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELK GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95624-1424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-813-2714
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9630 BRUCEVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELK GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95757-5512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-525-6421
Provider Business Practice Location Address Fax Number:
279-214-0220
Provider Enumeration Date:
10/31/2006

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:  8411T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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