Healthcare Provider Details

I. General information

NPI: 1538305982
Provider Name (Legal Business Name): JEFFREY L. BURCHAM, OPTOMETRIST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 24TH AVE SW
NORMAN OK
73069-5110
US

IV. Provider business mailing address

444 24TH AVE SW
NORMAN OK
73069-5110
US

V. Phone/Fax

Practice location:
  • Phone: 405-364-2020
  • Fax: 405-364-2021
Mailing address:
  • Phone: 405-364-2020
  • Fax: 405-364-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number152W00000X
License Number StateOK

VIII. Authorized Official

Name: JEFFREY L. BURCHAM
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 405-364-2020