Provider Demographics
NPI:1235539701
Name:HAAKE, JESSICA (OD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HAAKE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ROUTE 37 W STE G5
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-6588
Mailing Address - Country:US
Mailing Address - Phone:732-797-0104
Mailing Address - Fax:
Practice Address - Street 1:500 ROUTE 35 UNIT 510
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5038
Practice Address - Country:US
Practice Address - Phone:732-576-0155
Practice Address - Fax:732-210-6059
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00692100152W00000X
NJ27OA00692101152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist