Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 12753 | KS |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 12753 | KS |
N | 152WP0200X | Pediatric Optomitrist | 12753 | KS |
NPI | 1336110808 |
---|---|
Provider Name | Dr. Jay Jeffrey Burlingame |
First Address | Overland Park, KS 66213-2002 |
Second Address | Overland Park, KS 66213-2002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 09/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T71347 | (02) |