Healthcare Provider Details

I. General information

NPI: 1609017854
Provider Name (Legal Business Name): BURBANK EYECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 W VERDUGO AVE
BURBANK CA
91506-2150
US

IV. Provider business mailing address

1820 W VERDUGO AVE
BURBANK CA
91506-2150
US

V. Phone/Fax

Practice location:
  • Phone: 626-696-3607
  • Fax: 626-696-3608
Mailing address:
  • Phone: 747-261-7747
  • Fax: 818-841-1015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1201X
TaxonomyOptometric Assistant Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13140T
License Number StateCA

VIII. Authorized Official

Name: JANE KIM
Title or Position: OWNER
Credential: OD
Phone: 747-261-7747