Provider Demographics
NPI:1659677235
Name:AARON R MALLIE OD PA
Entity Type:Organization
Organization Name:AARON R MALLIE OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MALLIE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-732-5667
Mailing Address - Street 1:701 N CONGRESS AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-3418
Mailing Address - Country:US
Mailing Address - Phone:561-732-5667
Mailing Address - Fax:561-734-5788
Practice Address - Street 1:701 N CONGRESS AVE STE 2
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3418
Practice Address - Country:US
Practice Address - Phone:561-732-5667
Practice Address - Fax:561-734-5788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3916152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty