Burgess, Charles J
Burgess, Charles J is an individual health care provider with primary practice located at 1255 Appleton Rd Menasha, Menasha WI 54952-1501. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Burgess, Charles J can be contacted via phone (920) 722-6872.Contact Information
Primary practice address
1255 Appleton Rd Menasha
Menasha WI 54952-1501
Phone: (920) 722-6872
Fax: (920) 722-6335
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2676 | Wisconsin |
Profile Details
| NPI number | 1699768333 |
|---|---|
| LBN Legal business name | Burgess, Charles J |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 29th, 2005 |
| Last updated | May 8th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1699768333 | NPPES |
| Wisconsin | MEDICAID | 38601700 |
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