Healthcare Provider Details

I. General information

NPI: 1184080004
Provider Name (Legal Business Name): BURKE EYECARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 S MAIN ST
GROVE OK
74344-2801
US

IV. Provider business mailing address

24635 COUNTY ROAD 556
COLCORD OK
74338-3248
US

V. Phone/Fax

Practice location:
  • Phone: 918-786-2254
  • Fax:
Mailing address:
  • Phone: 417-252-1872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2840
License Number StateOK

VIII. Authorized Official

Name: DR. ROBERT BURKE
Title or Position: OWNER
Credential: O.D.
Phone: 417-252-1872