Provider Demographics
NPI:1730155565
Name:BURDEN, GAIL L (OD)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:L
Last Name:BURDEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 N WEBB RD
Mailing Address - Street 2:ATTN FLR2
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3413
Mailing Address - Country:US
Mailing Address - Phone:316-636-2010
Mailing Address - Fax:316-858-3830
Practice Address - Street 1:117 E NINTH
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156
Practice Address - Country:US
Practice Address - Phone:620-221-0740
Practice Address - Fax:620-221-0738
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100220240BMedicaid
KS410029592OtherRAILROAD MEDICARE
KSCD2825OtherRAIL ROAD MEDICARE GROUP
KS100220240BMedicaid
KS410029592OtherRAILROAD MEDICARE