Healthcare Provider Details

I. General information

NPI: 1649213273
Provider Name (Legal Business Name): MICHAEL D BURKHART O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 WOODLAND RD
WYOMISSING PA
19610-3231
US

IV. Provider business mailing address

245 GOLF RD
MYERSTOWN PA
17067-2205
US

V. Phone/Fax

Practice location:
  • Phone: 610-376-7272
  • Fax:
Mailing address:
  • Phone: 717-926-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOEG 000422
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG 000422
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: