Provider Demographics
NPI:1043216898
Name:MARGOLIES, MARK (OD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MARGOLIES
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 1:1724 KENDRICK ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-1816
Mailing Address - Country:US
Mailing Address - Phone:215-946-1221
Mailing Address - Fax:215-946-1225
Practice Address - Street 1:29 STONYBROOK DR
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19055-2216
Practice Address - Country:US
Practice Address - Phone:215-946-1221
Practice Address - Fax:215-946-1225
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000972152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA410024019OtherRAILROAD MEDICARE PROVIDER NUMBER/PTAN
PA001607401Medicaid
PA4444340001Medicare NSC
PA482645Medicare PIN
PAT30665Medicare UPIN