Healthcare Provider Details

I. General information

NPI: 1851477731
Provider Name (Legal Business Name): MARTHA DENISE BURNETT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTHA DENISE BURNETT-COLLINS O.D.

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9630 BRUCEVILLE RD
ELK GROVE CA
95757-5512
US

IV. Provider business mailing address

9751 KAPALUA LN
ELK GROVE CA
95624-1424
US

V. Phone/Fax

Practice location:
  • Phone: 916-525-6421
  • Fax: 279-214-0220
Mailing address:
  • Phone: 916-813-2714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8411T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: