Provider Demographics
NPI:1144285891
Name:BURTON, MICHAEL (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BURTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 W WHEATLAND RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3468
Mailing Address - Country:US
Mailing Address - Phone:972-780-7099
Mailing Address - Fax:972-780-9157
Practice Address - Street 1:3900 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3468
Practice Address - Country:US
Practice Address - Phone:972-780-7199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3411TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112397804Medicaid
TXP00630768OtherRAILROAD - GROUP MEMBER PTAN#
TX1548489388OtherRAILROAD - GROUP- NPI#
TX1144285891OtherRAILROAD - GROUP MEMBER NPI#
TX005FBOtherBCBSTX - GROUP#
TX197166501OtherMEDICAD - GROUP TPI#
TX410006619OtherRAILROAD - PROVIDER ID#
TX00Y945OtherNSC -MEDICARE GROUP PTAN#
TX80349QOtherBLUE CROSS BLUE SHIELD
DN6483OtherRAILROAD GROUP PTAN#
TX5238310001Medicare NSC
TX1548489388Medicare NSC