MEDICARE: DR. JEREMY ROSS BURNS 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	5615	OH
2	152W00000X	Optometrist	1621	SC

General Provider Information

NPI Number	:	1699889998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY ROSS BURNS OD

Provider Business Mailing Address
First Line	:	2428 REIDVILLE RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-3652
Country	:	US
Telephone Number	:	864-576-7225
Fax Number	:	864-576-7226

Provider Business Practice Location Address
First Line	:	2428 REIDVILLE RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-3652
Country	:	US
Telephone Number	:	864-576-7225
Fax Number	:	864-576-7226

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/26/2016

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