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General NPI Number Information
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NPI Number | 1598712440
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Entity Type | Individual
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Provider Name | RHETT MELVIN BURGENER OD
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Gender | Male
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 1923 MCCULLOCH BLVD #102
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-6722
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Country | US
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Telephone | 928-854-3555
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Fax | 928-854-4544
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Provider Business Mailing Address
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Address Line | 2525 TALISMAN LN
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86406-8267
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Country | US
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Telephone | 928-505-5843
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Fax | 928-854-9338
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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 | 1060
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License Number State | AZ
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