Healthcare Provider Details

I. General information

NPI: 1609228980
Provider Name (Legal Business Name): DAVID BURNS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

648 E 800 S COSTCO OPTICAL DEPARTMENT, C/O DR. DAVID BURNS
OREM UT
84097-6528
US

IV. Provider business mailing address

13688 S VESTRY RD
DRAPER UT
84020-7521
US

V. Phone/Fax

Practice location:
  • Phone: 801-851-5001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4759500
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: