MEDICARE: BURMAN & ZUCKERBROD OPHTHALMOLOGY ASSOCIATES, P.C

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
2	207W00000X	Ophthalmology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OP07250	OTHER	MI	MEDICARE PTAN

General Provider Information

NPI Number	:	1528140464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURMAN & ZUCKERBROD OPHTHALMOLOGY ASSOCIATES, P.C

Provider Business Mailing Address
First Line	:	43996 WOODWARD AVENUE
Second Line	:	SUITE 101
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-5028
Country	:	US
Telephone Number	:	248-332-4544
Fax Number	:	248-332-2716

Provider Business Practice Location Address
First Line	:	43996 WOODWARD AVENUE
Second Line	:	SUITE 101
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-5028
Country	:	US
Telephone Number	:	248-332-4544
Fax Number	:	248-332-2716

Authorized Official
Title or Position	:	VICE PRESIDENT/CEO
Name	:	DR. MATTHEW LLOYD BURMAN
Credential	:	M.D.
Telephone Number	:	248-332-4544

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	12/07/2012

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