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1336135003 NPI number — KERRY JAMES BURRELL O.D.

NPI Number: 1336135003
Health Care Provider/Practitioner: KERRY JAMES BURRELL O.D.

Information about “1336135003” NPI (KERRY JAMES BURRELL O.D.) exists in 1336135003 in HTML format HTML  |  1336135003 in plain Text format TXT  |  1336135003 in PDF (Portable Document Format) PDF  |  1336135003 in an XML format XML  formats.

NPI Number : 1336135003 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336135003",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BURRELL",
    "FirstName": "KERRY",
    "MiddleName": "JAMES",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "O.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "50 BERKSHIRE CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WYOMISSING",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "19610-1219",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "610-374-3134",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "50 BERKSHIRE COURT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WYOMISSING",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "19610-1219",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "610-374-3134",
    "PracticeLocationAddressFaxNumber": "610-374-0484",
    "EnumerationDate": "09/27/2005",
    "LastUpdateDate": "11/12/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "152W00000X",
        "TaxonomyName": "Optometrist",
        "LicenseNumber": "OEG001239",
        "LicenseNumberStateCode": "PA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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