NPI 1245255686 · live from the CMS NPI Registry
Ricky R Burk, OD
Optometrist in Tualatin, OR. National Provider Identifier 1245255686, active.
NPI record
| NPI | 1245255686 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | 19801 Sw 72nd Ave Ste 150, Tualatin, OR 97062 |
| Practice phone | 503-691-2283 |
| Mailing address | Po Box 1506, Chehalis, WA 98532 |
| Enumerated | July 13, 2006 |
| Last updated | November 4, 2020 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Optometrist primary | 152W00000X | ATI2559 (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.