Basic Information
| Provider Information | |||||||||
| NPI: | 1447608807 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURT | ||||||||
| FirstName: | JONATHAN | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2920 GLENDALE MILFORD RD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452413131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139229000 | ||||||||
| FaxNumber: | 5139224050 | ||||||||
| Practice Location | |||||||||
| Address1: | 5303 GLENWAY AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452383706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139218040 | ||||||||
| FaxNumber: | 5139216483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2016 | ||||||||
| LastUpdateDate: | 05/26/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 6446 | OH | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.