Healthcare Provider Details

I. General information

NPI: 1467637686
Provider Name (Legal Business Name): BURTON EYECARE ASSOCIATES, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 W GLENDALE AVE SUITE 101
PHOENIX AZ
85021-8578
US

IV. Provider business mailing address

1530 W GLENDALE AVE SUITE 101
PHOENIX AZ
85021-8578
US

V. Phone/Fax

Practice location:
  • Phone: 602-995-5883
  • Fax: 602-995-3365
Mailing address:
  • Phone: 602-995-5883
  • Fax: 602-995-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberAZ785
License Number StateAZ

VIII. Authorized Official

Name: DR. CHAD DOUGLAS BURTON
Title or Position: OWNER
Credential: O.D.
Phone: 602-995-2000