Healthcare Provider Details

I. General information

NPI: 1538113543
Provider Name (Legal Business Name): IRENE MUSTEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 CHESTNUT ST SUITE #105
PHILADELPHIA PA
19103-3401
US

IV. Provider business mailing address

408 BELLOWS LN
FEASTERVILLE TREVOSE PA
19053-7840
US

V. Phone/Fax

Practice location:
  • Phone: 215-563-8440
  • Fax:
Mailing address:
  • Phone: 267-684-6304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOEG001298
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001298
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: