Provider Demographics
NPI:1255855490
Name:JEANINE E. JACCO, OD PA
Entity Type:Organization
Organization Name:JEANINE E. JACCO, OD PA
Other - Org Name:VISION ASSOCIATES OF HACKETTSTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LABRADA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-321-6829
Mailing Address - Street 1:PO BOX 744
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-0744
Mailing Address - Country:US
Mailing Address - Phone:908-852-3900
Mailing Address - Fax:908-852-3903
Practice Address - Street 1:915 ROUTE 517 # B16
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-4661
Practice Address - Country:US
Practice Address - Phone:908-852-3900
Practice Address - Fax:908-852-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA000542200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty