Provider Demographics
NPI:1275595373
Name:HALPREN, JACK D (OD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:D
Last Name:HALPREN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-2116
Mailing Address - Country:US
Mailing Address - Phone:508-295-0752
Mailing Address - Fax:508-295-0991
Practice Address - Street 1:304 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-2116
Practice Address - Country:US
Practice Address - Phone:508-295-0752
Practice Address - Fax:508-295-0991
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA02456152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0334367Medicaid
161558Medicare ID - Type Unspecified
MA0334367Medicaid