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General NPI Number Information
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NPI Number | 1780766378
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Entity Type | Organization
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Legal Business Name | SAUM BURRUSS OPTOMETRY INC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 03/19/2009
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Provider Practice Location Address
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Address Line | 1350 E MAIN ST
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City | CARBONDALE
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State | IL
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Zip | 62901-3144
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Country | US
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Telephone | 618-529-3451
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 E MAIN ST
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City | CARBONDALE
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State | IL
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Zip | 62901-3144
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Country | US
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Telephone | 618-529-3451
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Fax |
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. SHARON SAUM BURRUSS
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Credential | OD
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Telephone | 618-203-6249
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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 | 046009628
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License Number State | IL
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