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LAN F BURCH OD

>> Optometrist >> Eye and Vision Services Providers

Registrant NPI Number: 1790750750

Individual Registrant:
 LAN F BURCH OD
Gender: M
Not Sole Proprietor

Location and contact information for practice:
201 S AVALON ST  WEST MEMPHIS, AR 72301-4172 US
Tel: 870-732-4701  Fax: 870-732-5400

Contact information for business:
201 S AVALON ST  WEST MEMPHIS, AR 72301-4172 US
Tel: 870-732-4701  Fax: 870-732-5400

Registration Information:
NPI: 1790750750
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y152W00000XEye and Vision Services Providers
Optometrist
AR2025

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
101945722AR05




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