Provider Demographics
NPI:1609825280
Name:BURTON, FRANK LLOYD (OD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:LLOYD
Last Name:BURTON
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 1:401 3RD ST
Mailing Address - Street 2:P.O. BOX 157
Mailing Address - City:AURORA
Mailing Address - State:IN
Mailing Address - Zip Code:47001-1311
Mailing Address - Country:US
Mailing Address - Phone:812-926-0942
Mailing Address - Fax:
Practice Address - Street 1:401 3RD ST BOX 157
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IN
Practice Address - Zip Code:47001-1311
Practice Address - Country:US
Practice Address - Phone:812-926-0942
Practice Address - Fax:812-926-4598
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001456B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100279210AMedicaid
IN964210Medicare PIN
INT69297Medicare UPIN
IN0149100001Medicare NSC