Provider Demographics
NPI:1821168758
Name:BAK, ISAAC (OD)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:
Last Name:BAK
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 1:849 EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1240
Mailing Address - Country:US
Mailing Address - Phone:215-688-1478
Mailing Address - Fax:609-734-8403
Practice Address - Street 1:1750 NOTTINGHAM WAY
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3551
Practice Address - Country:US
Practice Address - Phone:609-734-7572
Practice Address - Fax:609-734-8403
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00478100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ583697Medicare PIN