Doctor Name: | MR. ISSAM MALKOUN |
NPI Number: | 1740328418 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | OPTICIAN |
License Number: | 23273485 |
Business Practice Address: | 3103 Chichester Ave Boothwyn, PA - 190613117 |
Business Phone Number: | 6104944320 |
Business Fax Number: | |
Mailing Address: | 427 South Ave, MEDIA |
State: | PA |
Postal Code: | 190633215 |
Phone Number: | 6105669272 |
Fax Number: | |
NPI Enumeration Date: | 02/02/2007 |
NPI Last Update Date: | 05/02/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | 23273485 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |