Provider Demographics
NPI:1023534906
Name:KERRI BAKKER, O.D. LLC
Entity Type:Organization
Organization Name:KERRI BAKKER, O.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:908-319-7500
Mailing Address - Street 1:107 HOFFMAN CIR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-1553
Mailing Address - Country:US
Mailing Address - Phone:908-319-7500
Mailing Address - Fax:484-478-8050
Practice Address - Street 1:13 KEDRON AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:PA
Practice Address - Zip Code:19070-1513
Practice Address - Country:US
Practice Address - Phone:484-478-8000
Practice Address - Fax:484-478-8050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty