=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659425585
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID KENNETH BURNS OPTOMETRIST
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4621 EASTGATE BLVD
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45245-1203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-753-8172
-----------------------------------------------------
Fax | 513-752-5831
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6926 NUMBER FIVE RD
-----------------------------------------------------
City | PLEASANT PLAIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45162-9619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-625-1872
-----------------------------------------------------
Fax | --
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 3927
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------