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General NPI Number Information
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NPI Number | 1477105989
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Entity Type | Individual
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Provider Name | JASON MCBURNIE OD
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Gender | Male
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Dates
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Enumeration Date | 07/15/2019
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 1229 165TH ST
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City | HAMMOND
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State | IN
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Zip | 46320-2746
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Country | US
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Telephone | 219-931-8733
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Fax |
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Provider Business Mailing Address
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Address Line | 5 CHURCH RD
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City | HOLDEN
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State | ME
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Zip | 04429-7150
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Country | US
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Telephone |
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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-002366
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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 | 18004254
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License Number State | IN
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