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General NPI Number Information
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NPI Number | 1033288022
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Entity Type | Individual
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Provider Name | LISA ANN BURAKS O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 1601 S COLUMBUS BLVD WALMART VISION CENTER
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City | PHILADELPHIA
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State | PA
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Zip | 19148-1402
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Country | US
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Telephone | 215-389-5814
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Fax | 215-755-6561
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Provider Business Mailing Address
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Address Line | 10 WEATHERWOOD LN
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City | RADNOR
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State | PA
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Zip | 19087-2724
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Country | US
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Telephone | 215-530-3112
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Fax | 215-755-6561
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG000739
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License Number State | PA
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