Healthcare Provider Details

I. General information

NPI: 1275354680
Provider Name (Legal Business Name): ROBERT CHARLES BURDEN OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 BLOWING ROCK BLVD
LENOIR NC
28645-3785
US

IV. Provider business mailing address

935 BLOWING ROCK BLVD
LENOIR NC
28645-3785
US

V. Phone/Fax

Practice location:
  • Phone: 828-757-2812
  • Fax: 828-757-2864
Mailing address:
  • Phone: 828-757-2812
  • Fax: 828-757-2864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number2394
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: