Healthcare Provider Details

I. General information

NPI: 1043278716
Provider Name (Legal Business Name): BRIAN MICHAEL BURTON L.D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 CRIMSON LEAF LN
LIBERTY SC
29657-4202
US

IV. Provider business mailing address

134 CRIMSON LEAF LN
LIBERTY SC
29657-4202
US

V. Phone/Fax

Practice location:
  • Phone: 864-506-6256
  • Fax: 864-639-4012
Mailing address:
  • Phone: 864-506-6256
  • Fax: 864-639-4012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number242
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number776
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number6004
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number260
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: