Individual provider Active NPI

Burl R. Burgess, O.D.

  • Optometrist
  • Orange City, FL
National Provider Identifier
1174735500
Registry record updated Nov 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC944 Issued in FL
Practice address
2576 S Volusia Ave
Orange City, FL 32763-9120
Phone
(386) 774-6000
Fax
(386) 774-6971
NPI assigned
May 6, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC944 FL Primary

Addresses

Primary practice location

2576 S Volusia Ave
Orange City, FL 32763-9120

Mailing address

2576 S Volusia Ave
Orange City, FL 32763-9120
Phone (386) 774-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041207000292 FL Practitioner - Optometry 2365408861 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Gulf Coast Optometry, PA CurrentSince Mar 1, 2020 Accepting new patients
National Vision, Inc. Past Accepting new patients
National Vision, Inc. Past Accepting new patients

Locations

706 W State Road 436
Altamonte Springs, FL 32714
Phone (407) 774-1318

2254 W International Speedway Blvd
Daytona Beach, FL 32114
Phone (386) 252-3639

4957 S Cleveland Ave
Fort Myers, FL 33907
Phone (239) 278-1217

778 Beal Pkwy N
Unit 102
Fort Walton Beach, FL 32547
Phone (619) 321-7521

13534 Beach Blvd
#3
Jacksonville, FL 32224
Phone (904) 383-3400

2411 SW College Rd
Ocala, FL 34471
Phone (352) 873-3937

Networks

  • Freedom Health HMO Network

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194480000000",
    "number": "1174735500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2576 S VOLUSIA AVE",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327639120",
            "telephone_number": "386-774-6000",
            "fax_number": "386-774-6971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2576 S VOLUSIA AVE",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327639120",
            "telephone_number": "386-774-6000",
            "fax_number": "386-774-6971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGESS",
        "first_name": "BURL",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-06",
        "last_updated": "2007-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange City, FL

Sources for this page

Verify at the official NPI Registry.