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General NPI Number Information
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NPI Number | 1770899536
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Entity Type | Individual
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Provider Name | MARC A. BURCHAM O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/30/2010
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 265 BOARDMAN CANFIELD RD
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-4806
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Country | US
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Telephone | 330-726-6302
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Fax | 330-726-0025
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Provider Business Mailing Address
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Address Line | 11700 PRINCETON PIKE LENSCRAFTERS
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City | CINCINNATI
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State | OH
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Zip | 45246-2535
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Country | US
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Telephone | 513-671-5020
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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 | 5934
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License Number State | OH
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