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General NPI Number Information
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NPI Number | 1205064615
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Entity Type | Individual
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Provider Name | ALISON MARY BURD O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 04/01/2020
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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 | 573-431-3170
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Provider Business Mailing Address
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Address Line | 845 CIMARRON CIR
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City | FARMINGTON
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State | MO
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Zip | 63640-2157
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Country | US
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Telephone | 573-454-2940
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Fax | 573-454-2942
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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 | 2009016902
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License Number State | MO
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