Provider Demographics
NPI:1699883033
Name:BURCH, CHRISTIAN G (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:G
Last Name:BURCH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:324 E ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5563
Mailing Address - Country:US
Mailing Address - Phone:630-668-0378
Mailing Address - Fax:630-668-1989
Practice Address - Street 1:324 E ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5563
Practice Address - Country:US
Practice Address - Phone:630-668-0378
Practice Address - Fax:630-668-1989
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL00304600840301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2220256OtherBLUE CROSS BS
IL311460Medicare PIN
IL2220256OtherBLUE CROSS BS