Provider Demographics
NPI:1063233179
Name:BURDEN, JAYSON PAUL FERD (OD)
Entity type:Individual
Prefix:DR
First Name:JAYSON
Middle Name:PAUL FERD
Last Name:BURDEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 LINCOLNWAY E
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-2211
Mailing Address - Country:US
Mailing Address - Phone:574-255-1231
Mailing Address - Fax:
Practice Address - Street 1:517 LINCOLNWAY E
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-2211
Practice Address - Country:US
Practice Address - Phone:574-255-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004545A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist