Provider Demographics
NPI:1376540898
Name:BURG, STUART J (OD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:J
Last Name:BURG
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 1:252 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1113
Mailing Address - Country:US
Mailing Address - Phone:215-788-1022
Mailing Address - Fax:215-781-8071
Practice Address - Street 1:212 MILL ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-4809
Practice Address - Country:US
Practice Address - Phone:215-788-1022
Practice Address - Fax:215-781-8071
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000890152W00000X
NJ4001152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU07262Medicare UPIN
PABU98724Medicare ID - Type Unspecified