Healthcare Provider Details

I. General information

NPI: 1437157690
Provider Name (Legal Business Name): WILLIAM R BURGES O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 PARIS ST
CASTROVILLE TX
78009-4511
US

IV. Provider business mailing address

405 PARIS ST
CASTROVILLE TX
78009-4511
US

V. Phone/Fax

Practice location:
  • Phone: 830-538-2241
  • Fax: 830-931-3453
Mailing address:
  • Phone: 830-538-2241
  • Fax: 830-931-3453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2357TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: