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General NPI Number Information
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NPI Number | 1104969369
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Entity Type | Organization
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Legal Business Name | BURKE EYE CARE, INC.
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 2021 LYNNHAVEN PKWY SUITE A
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-1410
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Country | US
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Telephone | 757-471-4040
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Fax | 757-471-4077
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Provider Business Mailing Address
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Address Line | 2021 LYNNHAVEN PKWY SUITE A
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-1410
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Country | US
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Telephone | 757-471-4040
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Fax | 757-471-4077
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. LAURA N. BURKE
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Credential | O.D.
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Telephone | 757-471-4040
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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 | 0618001134
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License Number State | VA
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