MEDICARE: DR. PAUL J BURT O.D.

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	1278	SC

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	:	1902943145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL J BURT O.D.

Provider Business Mailing Address
First Line	:	2460 INDIA HOOK RD
Second Line	:	STE 206
City	:	ROCK HILL
State	:	SC
Zip	:	29732-3578
Country	:	US
Telephone Number	:	803-985-2020
Fax Number	:	803-985-2021

Provider Business Practice Location Address
First Line	:	2460 INDIA HOOK RD
Second Line	:	SUITE 206
City	:	ROCK HILL
State	:	SC
Zip	:	29732-3530
Country	:	US
Telephone Number	:	803-985-2020
Fax Number	:	803-985-2021

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	01/02/2018

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