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General NPI Number Information
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NPI Number | 1285891507
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Entity Type | Organization
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Legal Business Name | DAVID C BURGER OPTICAL
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 1459 E DOROTHY LN
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City | KETTERING
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State | OH
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Zip | 45429-3805
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Country | US
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Telephone | 937-294-6715
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Fax | 937-294-3955
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Provider Business Mailing Address
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Address Line | 1459 E DOROTHY LN
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City | KETTERING
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State | OH
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Zip | 45429-3805
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Country | US
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Telephone | 937-294-6715
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Fax | 937-294-3955
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID C BURGER
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Credential | OPTICIAN
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Telephone | 937-294-6715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 3288 SC
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License Number State | OH
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