Healthcare Provider Details

I. General information

NPI: 1164653846
Provider Name (Legal Business Name): ELIZABETH LORAYNE BURKHART O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH LORAYNE SCHULZ O.D.

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 S TELEPHONE RD
MOORE OK
73160-2937
US

IV. Provider business mailing address

2909 S TELEPHONE RD
MOORE OK
73160-2937
US

V. Phone/Fax

Practice location:
  • Phone: 405-799-7510
  • Fax: 405-799-4742
Mailing address:
  • Phone: 405-799-7510
  • Fax: 405-799-4742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2598
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: