Provider Demographics
NPI:1730133414
Name:SHIRK, MARGARET ANGELA (OD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:ANGELA
Last Name:SHIRK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELVERSON
Mailing Address - State:PA
Mailing Address - Zip Code:19520-9017
Mailing Address - Country:US
Mailing Address - Phone:610-913-0126
Mailing Address - Fax:610-913-0139
Practice Address - Street 1:2514 RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELVERSON
Practice Address - State:PA
Practice Address - Zip Code:19520-9017
Practice Address - Country:US
Practice Address - Phone:610-913-0126
Practice Address - Fax:610-913-2020
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001294152W00000X, 152WC0802X, 152WP0200X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001458505OtherHIGHMARK BLUE SHIELD ID
PA3802451OtherAETNA HMO PROVIDER NUMBER
PA2143489000OtherINDEPENDENCE BLUE CROSS
PA7686519OtherAETNA PPO PROVIDER NUMBER
PA7686519OtherAETNA PPO PROVIDER NUMBER
PA075703Medicare ID - Type UnspecifiedPA PROVIDER ID MEDICARE