MEDICARE: RHETT MELVIN BURGENER OD

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	152W00000X	Optometrist	1060	AZ

General Provider Information

NPI Number	:	1598712440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHETT MELVIN BURGENER OD

Provider Business Mailing Address
First Line	:	2525 TALISMAN LN
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86406-8267
Country	:	US
Telephone Number	:	928-505-5843
Fax Number	:	928-854-9338

Provider Business Practice Location Address
First Line	:	1923 MCCULLOCH BLVD #102
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6722
Country	:	US
Telephone Number	:	928-854-3555
Fax Number	:	928-854-4544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	02/15/2017

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Directions to “ RHETT MELVIN BURGENER OD” Practice Location

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