Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | 242 | SC |
N | 156FX1800X | Optician | 260 | HI |
N | 156FX1800X | Optician | 6004 | OH |
N | 156FX1800X | Optician | 776 | SC |
NPI | 1043278716 |
---|---|
Provider Name | Mr. Brian Michael Burton |
First Address | Liberty, SC 29657-4202 |
Second Address | Liberty, SC 29657-4202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DV7760 | (05) | SC |