Provider Demographics
NPI:1871595777
Name:SHORT, CHRISTOPHER MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:SHORT
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 1:1311 BRIDLE TRL
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-4702
Mailing Address - Country:US
Mailing Address - Phone:412-262-6139
Mailing Address - Fax:
Practice Address - Street 1:100 ROBINSON CENTER DR
Practice Address - Street 2:SUITE 2870
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-4831
Practice Address - Country:US
Practice Address - Phone:412-490-0820
Practice Address - Fax:412-490-2570
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001171152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01917852Medicaid
PASH344195OtherHIGHMARK BC/BS
PAPA7199OtherEYEMED
PAU93461Medicare UPIN
PA01917852Medicaid