Healthcare Provider Details

I. General information

NPI: 1437318391
Provider Name (Legal Business Name): BURKE D. MARTIN, OD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 S I H 35
ROUND ROCK TX
78664-7320
US

IV. Provider business mailing address

1308 ARRONIMINK CIR
AUSTIN TX
78746-6303
US

V. Phone/Fax

Practice location:
  • Phone: 512-388-2600
  • Fax: 512-388-0854
Mailing address:
  • Phone: 512-785-0624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5141T
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number5141T
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5141T
License Number StateTX

VIII. Authorized Official

Name: LYNNE K. MARTIN
Title or Position: OPTOMETRIST/BOOKKEEPER
Credential:
Phone: 512-785-0624