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General NPI Number Information
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NPI Number | 1306498787
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Entity Type | Individual
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Provider Name | ALEXANDRA DEMETRIA MCBURNIE OD
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Gender | Female
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Dates
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Enumeration Date | 07/15/2019
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 101 BEVERLY DR STE C
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City | CHESTERTON
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State | IN
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Zip | 46304-3471
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Country | US
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Telephone | 219-728-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 4315 CAMPBELL ST
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City | VALPARAISO
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State | IN
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Zip | 46385-1301
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Country | US
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Telephone | 812-345-0602
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Fax |
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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 | OPT-002367
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18004255A
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License Number State | IN
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