Provider Demographics
NPI:1457174740
Name:BURRILL, CLAIRE (OD)
Entity type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:
Last Name:BURRILL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:MI
Mailing Address - Zip Code:49688-9250
Mailing Address - Country:US
Mailing Address - Phone:269-362-1277
Mailing Address - Fax:
Practice Address - Street 1:211 MAPLE ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:MI
Practice Address - Zip Code:49688-9250
Practice Address - Country:US
Practice Address - Phone:269-362-1277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005843152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist