Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OEG000972 | PA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OEG000972 | PA |
NPI | 1043216898 |
---|---|
Provider Name | Mark Margolies |
First Address | Philadelphia, PA 19152-1816 |
Second Address | Levittown, PA 19055-2216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 30/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001607401 | (05) | PA |
410024019 | RAILROAD MEDICARE PROVIDER NUMBER/PTAN (01) | PA |
T30665 | (02) | PA |