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General NPI Number Information
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NPI Number | 1669651808
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Entity Type | Organization
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Legal Business Name | DAVID B. BURNETT P.C.
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 57 N MAIN ST
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City | FARMINGTON
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State | UT
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Zip | 84025-3517
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Country | US
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Telephone | 801-447-4393
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Fax | 801-447-8744
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Provider Business Mailing Address
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Address Line | 174 OAKRIDGE DR
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City | FARMINGTON
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State | UT
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Zip | 84025-3625
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Country | US
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Telephone | 801-447-4393
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Fax | 801-447-8744
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID BOYLE BURNETT
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Credential | O.D.
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Telephone | 801-447-4393
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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 | 5676092-9934
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License Number State | UT
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