=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730359837
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARGARET A. SHIRK O.D. & ASSOCIATES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2008
-----------------------------------------------------
Last Update Date | 02/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2514 RIDGE RD
-----------------------------------------------------
City | ELVERSON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19520-9017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-913-0126
-----------------------------------------------------
Fax | 610-913-0139
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2514 RIDGE RD
-----------------------------------------------------
City | ELVERSON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19520-9017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-913-0126
-----------------------------------------------------
Fax | 610-913-0139
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPTOMETRIST
-----------------------------------------------------
Name | DR. MARGARET A. SHIRK
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 610-212-2433
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number | OEG001294
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152WP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Optometrist
-----------------------------------------------------
License Number | OEG001294
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OEG001294
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------