MR. ISSAM MALKOUN (NPI# 1740328418) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740328418 |
| Entity Type | Individual |
| Full Name | MR. ISSAM MALKOUN |
| Credential | OPTICIAN |
| Practice Address |
3103 Chichester Ave Boothwyn PA 19061-3117 |
| Mailing Address |
427 South Ave Media PA 19063-3215 |
| Practice Telephone | 6104944320 |
| Mailing Telephone | 6105669272 |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2011-05-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 156FX1800X |
Technician/Technologist Specialization: Optician |
23273485 | PA | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NSC | 0134700001 | 01 |
| Street Address |
3103 CHICHESTER AVE |
| City | BOOTHWYN |
| State | PA |
| Zip Code | 19061-3117 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386932010 | Ems Factory Inc | Ambulance | 1628 Huddell Avenue, Boothwyn, PA 19061 | 2011-07-15 |
| 1194928655 | Patricia Anne Wardius | Dentist | 3129 Naamans Creek Road, Boothwyn, PA 19061 | 2007-06-11 |
| 1912110438 | Critical Care Systems | Preferred Provider Organization | 3901 Columbia Avenue, Suite100, Linwood, PA 19061 | 2007-05-08 |
| 1205048790 | Diane Faith Senn | Pharmacist | 643 Conchester Highway, Boothwyn, PA 19061 | 2007-05-04 |
| 1205048709 | Nicole Marie Nelson | Speech-Language Pathologist | Naamans Creek Country Manor, 1194 Naamans Creek Road, Boothwyn, PA 19061 | 2007-05-04 |
| 1932221322 | Marcus Hook-trainer Fire Dept Station 68 Inc | Ambulance | 617 East 10 St, Marcus Hook, PA 19061 | 2007-04-04 |
| 1215059175 | Sarah Margaret Clark | Physical Therapist | 1194 Naanans Creek Rd, Boothwyn, PA 19061 | 2007-04-04 |
| 1235257783 | Julie Ramsey | Occupational Therapist | 1194 Naamans Creek Road, Boothwyn, PA 19061 | 2007-03-26 |
| 1316071293 | Nancy Elizabeth Jordan | Physical Therapist | 1531 Springmeadow Ln., Boothwyn, PA 19061 | 2007-03-15 |
| 1306979133 | Elwyn | Intermediate Care Facility, Mentally Retarded | 5240 Chichester Ave., Boothwyn, PA 19061 | 2007-03-13 |
| Find all providers in zip 19061 | ||||
| Taxonomy Code | 156FX1800X |
| Grouping | Eye and Vision Services Providers |
| Classification | Technician/Technologist |
| Specialization | Optician |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962623322 | Consolidated Vision Group | Technician/Technologist | 621 Conchester Hwy, Suite 11, Boothwyn, PA 19061-3147 | 2007-05-02 |
| 1962585406 | Wal-mart Stores East, Lp | Technician/Technologist | 605 Conchester Hwy, Boothwyn, PA 19061-3147 | 2006-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194332445 | Kevin Lee Treat | Technician/Technologist | 144 Bear Hollow Ln, Falls, PA 18615-7777 | 2020-09-29 |
| 1316585102 | Devrick Jamal Cliett Sr. | Technician/Technologist | 225 Wilmington Pike, Suite 200, Chadds Ford, PA 19317 | 2019-12-12 |
| 1407409568 | Leslie Pinkney | Technician/Technologist | 4902 Pulaski Ave, Philadelphia, PA 19144-4131 | 2019-07-18 |
| 1770140816 | Optical Shop of New Hope Inc. | Technician/Technologist | 102 S Main St Ste C, New Hope, PA 18938-2200 | 2019-05-23 |
| 1164988622 | National Vision Inc | Technician/Technologist | 1136 Commerce Blvd, Dickson City, PA 18519-1688 | 2019-02-20 |
| 1033673595 | National Vision Inc | Technician/Technologist | 1930 Douglas Pkwy Ste 54, Erie, PA 16509-7304 | 2019-01-29 |
| 1245712520 | Milissa Parker | Technician/Technologist | 521 S Oxford Valley Rd, Fairless Hills, PA 19030-2612 | 2018-09-03 |
| 1619469673 | National Vision, Inc. | Technician/Technologist | 1265 Knapp Rd, North Wales, PA 19454-1831 | 2018-06-05 |
| 1326536335 | Mark Jay Miller | Technician/Technologist | 3617 Sipler Ln, Huntingdon Valley, PA 19006-3223 | 2018-04-25 |
| 1861995938 | Spectix Haverford | Technician/Technologist | 222 W Rittenhouse Sq, Philadelphia, PA 19103-5705 | 2018-03-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.