Individual
MR. ISSAM MALKOUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
3103 CHICHESTER AVE, BOOTHWYN, PA 19061-3117
(610) 494-4320
Mailing address
427 SOUTH AVE, MEDIA, PA 19063-3215
(610) 566-9272
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
23273485
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0134700001
NSC
—
Enumeration date
02/02/2007
Last updated
05/02/2011
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