Provider Demographics
NPI:1851084875
Name:ENGSTROM, ISAIAH (DOCTOR OF OPTOMETRY)
Entity Type:Individual
Prefix:
First Name:ISAIAH
Middle Name:
Last Name:ENGSTROM
Suffix:
Gender:M
Credentials:DOCTOR OF OPTOMETRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 RIDGETOP CT
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-1880
Mailing Address - Country:US
Mailing Address - Phone:724-787-0930
Mailing Address - Fax:
Practice Address - Street 1:2 ROUTE 37 W STE G5
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-6588
Practice Address - Country:US
Practice Address - Phone:732-797-0104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00721200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist