MEDICARE: AMBER BURKS, O.D., P.A.

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	OPC4576	FL

General Provider Information

NPI Number	:	1942507934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBER BURKS, O.D., P.A.

Provider Business Mailing Address
First Line	:	510 NW 84TH AVE APT 114
Second Line	:	#114
City	:	PLANTATION
State	:	FL
Zip	:	33324-1846
Country	:	US
Telephone Number	:	954-397-3717
Fax Number	:	954-571-2922

Provider Business Practice Location Address
First Line	:	100 S MILITARY TRL
Second Line	:	SUITE 6
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-3032
Country	:	US
Telephone Number	:	954-571-1701
Fax Number	:	954-571-2922

Authorized Official
Title or Position	:	PRESIDENT/OPTOMETRIST
Name	:	DR. AMBER BURKS
Credential	:	O.D., P.A.
Telephone Number	:	954-571-1701

Provider Enumeration Date	:	02/28/2011
Last Update Date	:	02/28/2011

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