Provider Demographics
NPI:1508983354
Name:ISAAC, DANIEL H (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:H
Last Name:ISAAC
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 1:1032 CHERRY HILL MALL
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002
Mailing Address - Country:US
Mailing Address - Phone:856-665-4111
Mailing Address - Fax:856-665-0843
Practice Address - Street 1:1032 CHERRY HILL MALL
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2100
Practice Address - Country:US
Practice Address - Phone:856-665-4111
Practice Address - Fax:856-665-0843
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00437300152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ35163OtherAETNA
NJ439049Medicare ID - Type Unspecified
NJU40394Medicare UPIN