Active NPI
Richard G. Bursua, O.D.
- Optometrist
- Marion, IL
National Provider Identifier
1467533646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046006213
- Practice address
- 1306 N . Russell St.
Marion, IL 62959 - Phone
- (618) 997-6438
- Fax
- (618) 997-6430
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046006213 | IL | Primary |
Addresses
Primary practice location
1306 N . Russell St.
Marion, IL 62959
Mailing address
PO Box 1689
Marion, IL 62959-7889
Phone (618) 997-6438
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 046006213 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046006213 | IL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234137600000",
"number": "1467533646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1689",
"city": "MARION",
"state": "IL",
"postal_code": "629597889",
"telephone_number": "618-997-6438",
"fax_number": "618-997-6430"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1306 N . RUSSELL ST.",
"city": "MARION",
"state": "IL",
"postal_code": "62959",
"telephone_number": "618-997-6438",
"fax_number": "618-997-6430"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURSUA",
"first_name": "RICHARD",
"middle_name": "G.",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-17",
"last_updated": "2009-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046006213",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "046006213",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marion, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.