MEDICARE: JUSTIN BURTNER 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	2102	AZ
2	152W00000X	Optometrist	OPC5629	FL

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

General Provider Information

NPI Number	:	1891159356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN BURTNER OD

Provider Business Mailing Address
First Line	:	5528 US HIGHWAY 98 N
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33809-3104
Country	:	US
Telephone Number	:	863-853-2020
Fax Number	:	863-577-2008

Provider Business Practice Location Address
First Line	:	5528 US HIGHWAY 98 N
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33809-3104
Country	:	US
Telephone Number	:	863-853-2020
Fax Number	:

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

Provider Enumeration Date	:	04/11/2016
Last Update Date	:	01/14/2020

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Directions to “ JUSTIN BURTNER OD” Practice Location

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