Healthcare Provider Details

I. General information

NPI: 1093808925
Provider Name (Legal Business Name): CHERYL A BURNETTE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1462 KNOLL PARK LN
FALLBROOK CA
92028-1727
US

IV. Provider business mailing address

1462 KNOLL PARK LN
FALLBROOK CA
92028-1727
US

V. Phone/Fax

Practice location:
  • Phone: 760-468-5544
  • Fax:
Mailing address:
  • Phone: 760-468-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9972T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: