Provider Demographics
NPI:1699889998
Name:BURNS, JEREMY ROSS (OD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:ROSS
Last Name:BURNS
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 1:2428 REIDVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-3652
Mailing Address - Country:US
Mailing Address - Phone:864-576-7225
Mailing Address - Fax:864-576-7226
Practice Address - Street 1:2428 REIDVILLE RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-3652
Practice Address - Country:US
Practice Address - Phone:864-576-7225
Practice Address - Fax:864-576-7226
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5615152W00000X
SC1621152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist