Provider Demographics
NPI:1538113543
Name:MUSTEN, IRENE (OD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:MUSTEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 BELLOWS LN
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-7840
Mailing Address - Country:US
Mailing Address - Phone:267-684-6304
Mailing Address - Fax:
Practice Address - Street 1:1919 CHESTNUT ST
Practice Address - Street 2:SUITE #105
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-3401
Practice Address - Country:US
Practice Address - Phone:215-563-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001298152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMU1644335OtherHIGHMARK BLUE SHIELD
PA3562881OtherAETNA HMO
PA9252339OtherCIGNA
PA7991573OtherAETNA PPO
PA3562881OtherAETNA HMO
PAMU1644335OtherHIGHMARK BLUE SHIELD
PA9252339OtherCIGNA