Blaine Landon Burdick, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

675 Issued in ND

Practice address

211 4TH St NE Ste 1
Devils Lake, ND 58301-2479

Phone

(701) 662-2817

Fax

(701) 662-2040

NPI assigned

Jul 17, 2008

Last updated

Apr 8, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in ND

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

Specialty

Optometry

Education

Pacific University - College of Optometry, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

DRS Moen Enderle and Krein PCGroup PAC ID 9638072440, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• DRS Moen Enderle and Krein PC

  • Optometrist
  • Devils Lake, ND
  • NPI 1265539639
  Medicare reassignment Care Compare group NPD
• DRS Moen Enderle and Krein PC

  dba 20/20 EyeCare

  • Optometrist
  • Devils Lake, ND
  • NPI 1598944373
  NPD Authorized official

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

{
    "created_epoch": "1216252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270684800000",
    "number": "1235393489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 4TH ST NE STE 1",
            "address_2": "P O BOX 888",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583012479",
            "telephone_number": "701-662-2817",
            "fax_number": "701-662-2040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 4TH ST NE STE 1",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583012479",
            "telephone_number": "701-662-2817",
            "fax_number": "701-662-2040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURDICK",
        "first_name": "BLAINE",
        "middle_name": "LANDON",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-17",
        "last_updated": "2010-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ND",
            "license": "675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND BLUE CROSS/SHIELD",
            "identifier": "1235393489",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND VISION SERVICES",
            "identifier": "893212",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60678",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tammy Brooks
• Alexis Nicole Brown
• Heidi Brown, SLP
• Gerianne Brunelle
• Tracy Kay Buckmeier
• Tara Bushard
• Christine J Bushy
• Tonya R Bussell, LAC
• Carly Carlson
• Becky L Carow, LSW

• Optometrist in Devils Lake, ND
• Providers in Devils Lake, ND by specialty
• Optometrist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.