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General NPI Number Information
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NPI Number | 1083970800
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Entity Type | Organization
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Legal Business Name | BURD'S EYE VIEW, PC
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 07/06/2012
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Provider Practice Location Address
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Address Line | 407 N STATE ST
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City | DESLOGE
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State | MO
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Zip | 63601-3053
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Country | US
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Telephone | 573-431-2974
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Fax |
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Provider Business Mailing Address
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Address Line | 618 SAINT FRANCOIS RD
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City | BONNE TERRE
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State | MO
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Zip | 63628-9201
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Country | US
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Telephone | 573-562-8096
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. ALISON MARY BURD
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Credential | OD
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Telephone | 573-562-8096
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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 | 2009016902
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License Number State | MO
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