MEDICARE: DR. EDMUND W BURDICK 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	OEG000478	PA

General Provider Information

NPI Number	:	1598759383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDMUND W BURDICK OD

Provider Business Mailing Address
First Line	:	PO BOX 423
Second Line	:
City	:	NEW MILFORD
State	:	PA
Zip	:	18834-0423
Country	:	US
Telephone Number	:	570-465-3188
Fax Number	:	570-465-3187

Provider Business Practice Location Address
First Line	:	188 CHURCH ST
Second Line	:
City	:	NEW MILFORD
State	:	PA
Zip	:	18834-2104
Country	:	US
Telephone Number	:	570-465-3188
Fax Number	:	570-465-3187

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	01/29/2008

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