Shannon M. Burgess, OD

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

OEG000127 Issued in PA

Legal business name

SHANNON M. BURGESS, OD

Practice address

1260 Valley Forge Rd
Suite 108
Phoenixville, PA 19460-2691

Phone

(610) 917-0700

Fax

(610) 917-0708

NPI assigned

Dec 1, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Shannon M. Burgess, O.D.NPI 1457313835

Title

Optometrist

Phone

(610) 917-0700

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Valley Forge Eye Care Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shannon M Burgess, O.D.

  • Optometrist
  • Phoenixville, PA
  • NPI 1457313835
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1291161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314230400000",
    "number": "1275835829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 VALLEY FORGE RD",
            "address_2": "SUITE 108",
            "city": "PHOENIXVILLE",
            "state": "PA",
            "postal_code": "194602691",
            "telephone_number": "610-917-0700",
            "fax_number": "610-917-0708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 VALLEY FORGE RD",
            "address_2": "SUITE 108",
            "city": "PHOENIXVILLE",
            "state": "PA",
            "postal_code": "194602691",
            "telephone_number": "610-917-0700",
            "fax_number": "610-917-0708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANNON M. BURGESS, OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-01",
        "last_updated": "2011-08-25",
        "status": "A",
        "authorized_official_last_name": "BURGESS",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "610-917-0700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "PA",
            "license": "OEG000127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE HEALTH PLAN",
            "identifier": "2013716000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "001321149",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "50004981",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Forge Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Medical Specialty Clinic/Center in Phoenixville, PA
• Providers in Phoenixville, PA by specialty
• Medical Specialty Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.