Healthcare Provider Details

I. General information

NPI: 1497341705
Provider Name (Legal Business Name): EYEDIOLOGY VISION CARE BURKE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 S GRAND CANYON DR STE 105
LAS VEGAS NV
89147-7155
US

IV. Provider business mailing address

4175 S GRAND CANYON DR STE 105
LAS VEGAS NV
89147-7155
US

V. Phone/Fax

Practice location:
  • Phone: 702-912-4254
  • Fax: 702-847-7624
Mailing address:
  • Phone: 702-912-4254
  • Fax: 702-847-7624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER KATHLEEN BURKE
Title or Position: OWNER
Credential: OD
Phone: 702-912-4254