Provider Demographics
NPI:1982761052
Name:GAYLE, BURNIS (OD)
Entity type:Individual
Prefix:MS
First Name:BURNIS
Middle Name:
Last Name:GAYLE
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 1:3806 67TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-6009
Mailing Address - Country:US
Mailing Address - Phone:806-798-9900
Mailing Address - Fax:806-798-9944
Practice Address - Street 1:5201 68TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-1508
Practice Address - Country:US
Practice Address - Phone:806-798-9900
Practice Address - Fax:806-798-9944
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00396EMedicare ID - Type Unspecified
TXU12219Medicare UPIN