Provider Demographics
NPI:1124146667
Name:MARC MISHAN O.D., P.C.
Entity type:Organization
Organization Name:MARC MISHAN O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:MISHAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-738-3700
Mailing Address - Street 1:8227 153RD AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-1751
Mailing Address - Country:US
Mailing Address - Phone:718-738-3700
Mailing Address - Fax:
Practice Address - Street 1:8227 153RD AVE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1751
Practice Address - Country:US
Practice Address - Phone:718-738-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0923440001Medicare NSC