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General NPI Number Information
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NPI Number | 1942507934
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Entity Type | Organization
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Legal Business Name | AMBER BURKS, O.D., P.A.
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 100 S MILITARY TRL SUITE 6
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-3032
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Country | US
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Telephone | 954-571-1701
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Fax | 954-571-2922
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Provider Business Mailing Address
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Address Line | 510 NW 84TH AVE APT 114 #114
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City | PLANTATION
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State | FL
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Zip | 33324-1846
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Country | US
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Telephone | 954-397-3717
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Fax | 954-571-2922
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Authorized Official
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Title or Position | PRESIDENT/OPTOMETRIST
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Name | DR. AMBER BURKS
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Credential | O.D., P.A.
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Telephone | 954-571-1701
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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 | OPC4576
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License Number State | FL
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