Provider Demographics
NPI:1366555468
Name:BURKE, CHRISTINE LAURA (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:LAURA
Last Name:BURKE
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 1:49 CHOCTAW TRL
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4352
Mailing Address - Country:US
Mailing Address - Phone:860-877-6034
Mailing Address - Fax:
Practice Address - Street 1:3 PINE CONE DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8685
Practice Address - Country:US
Practice Address - Phone:386-446-9590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC6237152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist