Erik Duane Burgwald, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046008644 Issued in IL

Practice address

1711 S Neil St
Champaign, IL 61820

Phone

(217) 359-2390

Fax

(217) 359-3180

NPI assigned

Jan 24, 2006

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 2

Medicare fee-for-service enrollment

Enrolled in IL

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

Illinois College of Optometry at Chicago, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jones Optical IncGroup PAC ID 9537266895, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Jones Optical Inc

  • Optometrist
  • Champaign, IL
  • NPI 1376672998
  Medicare reassignment Care Compare group Authorized official
• Laughton Chiropractic Clinic, LLC

  • Chiropractor
  • Mahomet, IL
  • NPI 1811129836
  NPD (past)

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438300800000",
    "number": "1689644684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1711 S NEIL ST",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "61820",
            "telephone_number": "217-359-2390",
            "fax_number": "217-359-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 S NEIL ST",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "61820",
            "telephone_number": "217-359-2390",
            "fax_number": "217-359-3180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGWALD",
        "first_name": "ERIK",
        "middle_name": "DUANE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2015-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046008644",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DPR",
            "identifier": "046008649",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DPR",
            "identifier": "346000884",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brad R Buldak
• Amy Bullington, MS, CADC
• Rachel Bunyard
• Manuel Dejesus Burgos Jr.
• Priscilla Burgos, RBT
• Andrea Burie, M.S. CCC-SLP
• Hannah Rose Burkiett
• Brandi Elizabeth Burque, PH.D.
• Rachel Burris, RBT
• Nicole Marie Busch I

• Optometrist in Champaign, IL
• Providers in Champaign, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2015; 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.