Individual
BRENT D. BURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
7625 SOUTHTOWN XING, FORT WAYNE, IN 46816-2517
(260) 447-9731
(260) 441-8276
Mailing address
10529 HOSLER RD STE A, LEO, IN 46765-9736
(260) 627-2669
(260) 627-2011
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002685A
IN
152W00000X
Optometrist
2358
CO
Other
Enumeration date
09/24/2008
Last updated
12/10/2012
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