=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083717292
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT FRANKLYN BURKE O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2006
-----------------------------------------------------
Last Update Date | 10/31/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1105 S MAIN ST
-----------------------------------------------------
City | GROVE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74344-2801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-786-2254
-----------------------------------------------------
Fax | 918-786-2114
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1105 S MAIN ST
-----------------------------------------------------
City | GROVE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74344-2801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-786-2254
-----------------------------------------------------
Fax | 918-786-2114
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2840
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2007020378
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------