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Individual

DR. RICKY R BURK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
19801 SW 72ND AVE STE 150, TUALATIN, OR 97062-8347
(503) 691-2283
(503) 691-5981
Mailing address
PO BOX 1506, CHEHALIS, WA 98532-0409
(360) 242-3008
(360) 807-7687

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ATI2559
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1023231
AK
05
1245255686
ID
05
2019370
WA
05
209408
OR
01
410031420
RAIL ROAD MEDICARE
WA
01
410031421
RAIL ROAD MEDICARE
OR
01
410031423
RAIL ROAD MEDICARE
WA
01
410031424
RAIL ROAD MEDICARE
ID
01
410031425
RAILROAD MEDICARE
WA
01
410031427
RAIL ROAD MEDICARE
ID
01
410031428
RAIL ROAD MEDICARE
WA
01
410031429
RAIL ROAD MEDICARE
WA
01
410031430
RAIL ROAD MEDICARE
WA
01
410045000
RAIL ROAD MEDICARE
AK
Enumeration date
07/13/2006
Last updated
11/04/2020
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