MEDICARE: MARK POLLACK OD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1154525111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK POLLACK OD PA

Provider Business Mailing Address
First Line	:	106 FERRY ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07105-2106
Country	:	US
Telephone Number	:	973-344-2212
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 FERRY ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07105-2106
Country	:	US
Telephone Number	:	973-589-8085
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARK POLLACK
Credential	:	OD
Telephone Number	:	973-344-2212

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	04/11/2024

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