Provider Demographics
NPI:1174540652
Name:BURNS, STANLEY JOEL (OD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:JOEL
Last Name:BURNS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:STANLEY
Other - Middle Name:J
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2811 LORD BALTIMORE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244
Mailing Address - Country:US
Mailing Address - Phone:443-316-2101
Mailing Address - Fax:410-265-6068
Practice Address - Street 1:4301 GARDEN CITY DRIVE
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20783
Practice Address - Country:US
Practice Address - Phone:301-459-8252
Practice Address - Fax:301-577-5341
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8601152W00000X
VA574152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist