Provider Demographics
NPI:1669610119
Name:BURTON, THOMAS CARL (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:CARL
Last Name:BURTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1017 SWEETBRIAR DRIVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-6720
Mailing Address - Country:US
Mailing Address - Phone:262-549-6887
Mailing Address - Fax:262-549-6887
Practice Address - Street 1:1017 SWEETBRIAR DRIVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-6720
Practice Address - Country:US
Practice Address - Phone:262-549-6887
Practice Address - Fax:262-549-6887
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI25769-020207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology