Basic Information
| Provider Information | |||||||||
| NPI: | 1659677235 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AARON R MALLIE OD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 N CONGRESS AVE STE 2 | ||||||||
| Address2: | |||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334263418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617325667 | ||||||||
| FaxNumber: | 5617345788 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 N CONGRESS AVE STE 2 | ||||||||
| Address2: | |||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334263418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617325667 | ||||||||
| FaxNumber: | 5617345788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2011 | ||||||||
| LastUpdateDate: | 01/31/2011 | ||||||||
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| AuthorizedOfficialLastName: | MALLIE | ||||||||
| AuthorizedOfficialFirstName: | AARON | ||||||||
| AuthorizedOfficialMiddleName: | RICHARD | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 5617325667 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC 3916 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.