MEDICARE: DR. JOHN MICHAEL BURKE O.D.

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	1004	NC

General Provider Information

NPI Number	:	1700888492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MICHAEL BURKE O.D.

Provider Business Mailing Address
First Line	:	2630 PETERS CREEK PKWY
Second Line	:
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27127-5655
Country	:	US
Telephone Number	:	336-785-3486
Fax Number	:	336-785-3002

Provider Business Practice Location Address
First Line	:	2630 PETERS CREEK PKWY
Second Line	:
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27127-5655
Country	:	US
Telephone Number	:	336-785-3486
Fax Number	:	336-785-3002

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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