MEDICARE: ERICA S. BURTON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	T03295	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	118961	OTHER	MO	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518962059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA S. BURTON OD

Provider Business Mailing Address
First Line	:	808 GULF ST
Second Line	:
City	:	LAMAR
State	:	MO
Zip	:	64759-1239
Country	:	US
Telephone Number	:	417-682-3301
Fax Number	:	417-682-2409

Provider Business Practice Location Address
First Line	:	808 GULF ST
Second Line	:
City	:	LAMAR
State	:	MO
Zip	:	64759-1239
Country	:	US
Telephone Number	:	417-682-3301
Fax Number	:	417-682-2409

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	01/18/2011

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