Organization
SHANNON M. BURGESS, OD
Active
Other names
Valley Forge Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANNON M. BURGESS O.D. (OPTOMETRIST)
(610) 917-0700
Entity
Organization
Contact information
Practice address
1260 VALLEY FORGE RD, SUITE 108, PHOENIXVILLE, PA 19460-2691
(610) 917-0700
(610) 917-0708
Mailing address
1260 VALLEY FORGE RD, SUITE 108, PHOENIXVILLE, PA 19460-2691
(610) 917-0700
(610) 917-0708
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
OEG000127
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001321149
BLUE SHIELD
—
01
—
2013716000
KEYSTONE HEALTH PLAN
—
01
—
50004981
CAPITAL BLUE CROSS
—
Enumeration date
12/01/2010
Last updated
08/25/2011
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