Provider Demographics
NPI:1639368038
Name:DANIEL H. ISAAC, O.D., P.A.
Entity Type:Organization
Organization Name:DANIEL H. ISAAC, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:ISAAC
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:856-665-4111
Mailing Address - Street 1:1032 CHERRY HILL MALL
Mailing Address - Street 2:RT. 38 AND HADDONFIELD RD.
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:RT. 38 AND HADDONFIELD RD.
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002
Practice Address - Country:US
Practice Address - Phone:856-665-4111
Practice Address - Fax:856-665-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ27OA00437300152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ35163OtherAETNA
NJ=========OtherTIN
NJ=========OtherTIN
NJ35163OtherAETNA