Healthcare Provider Details

I. General information

NPI: 1700884525
Provider Name (Legal Business Name): SANDLER L BURKLEY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date: 03/17/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

3020 LEE BLVD
LEHIGH ACRES FL
33971-2438
US

IV. Provider business mailing address

9617 GULF RESEARCH LN
FORT MYERS FL
33912-4555
US

V. Phone/Fax

Practice location:
  • Phone: 239-418-0999
  • Fax: 239-418-0091
Mailing address:
  • Phone: 239-418-0999
  • Fax: 239-418-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC1074
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: