MEDICARE: BURNS OPTICAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier		MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7771	OTHER	MO	HC USA

General Provider Information

NPI Number	:	1023285210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURNS OPTICAL

Provider Business Mailing Address
First Line	:	2421 W EDGEWOOD DR STE A
Second Line	:
City	:	JEFFERSON CTY
State	:	MO
Zip	:	65109-5844
Country	:	US
Telephone Number	:	573-636-2103
Fax Number	:	573-636-9267

Provider Business Practice Location Address
First Line	:	2421 W EDGEWOOD DR STE A
Second Line	:
City	:	JEFFERSON CTY
State	:	MO
Zip	:	65109-5844
Country	:	US
Telephone Number	:	573-636-2103
Fax Number	:	573-636-9267

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL DONALD BURNS
Credential	:
Telephone Number	:	573-636-2103

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	05/15/2008

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Directions to “BURNS OPTICAL ” Practice Location

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