Individual
SHANNON M BURGESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000127
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019559700001
—
PA
01
—
1321149
HIGHMARK BLUE SHIELD
PA
01
—
2669841
AETNA
PA
01
—
410047758
RAILROAD MEDICARE
PA
01
—
50004981
CAPITAL BLUE CROSS
PA
Enumeration date
04/03/2006
Last updated
10/12/2011
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