Active NPI
Emerson Lynn Burge, O.D.
- Optometrist
- Oak Harbor, WA
National Provider Identifier
1699807784
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- TX 1120
- Practice address
- 390 E Whidbey Ave
Oak Harbor, WA 98277-2573 - Phone
- (360) 675-2295
- NPI assigned
- Mar 12, 2007
- 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 | TX 1120 | WA | Primary |
Addresses
Primary practice location
390 E Whidbey Ave
Oak Harbor, WA 98277-2573
Mailing address
390 E Whidbey Ave
Oak Harbor, WA 98277-2573
Phone (360) 675-2295
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| BURGG 23760 | Other | WA | SKAGIT COUNTY MEDICAL BUR |
| 061044001 | Other | WA | GROUP HEALTH |
| 2012102 | Medicaid | WA |
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 |
|---|---|---|---|
| TX 1120 | WA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246320000000",
"number": "1699807784",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "390 E WHIDBEY AVE",
"city": "OAK HARBOR",
"state": "WA",
"postal_code": "982772573",
"telephone_number": "360-675-2295"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "390 E WHIDBEY AVE",
"city": "OAK HARBOR",
"state": "WA",
"postal_code": "982772573",
"telephone_number": "360-675-2295"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGE",
"first_name": "EMERSON",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-12",
"last_updated": "2009-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WA",
"license": "TX 1120",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SKAGIT COUNTY MEDICAL BUR",
"identifier": "BURGG 23760",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP HEALTH",
"identifier": "061044001",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2012102",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oak Harbor, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.