Individual
DR. RICHARD G. BURSUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1306 N . RUSSELL ST., MARION, IL 62959
(618) 997-6438
(618) 997-6430
Mailing address
PO BOX 1689, MARION, IL 62959-7889
(618) 997-6438
(618) 997-6430
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046006213
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046006213
—
IL
Enumeration date
10/17/2006
Last updated
02/09/2009
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