Provider Demographics
NPI:1457448730
Name:HABERMAN, TERRI DAWN (OD)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:DAWN
Last Name:HABERMAN
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 1:460 WOODBRIDGE CTR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-1305
Mailing Address - Country:US
Mailing Address - Phone:732-636-2112
Mailing Address - Fax:732-636-2898
Practice Address - Street 1:460 WOODBRIDGE CTR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-1305
Practice Address - Country:US
Practice Address - Phone:732-636-2112
Practice Address - Fax:732-636-2898
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT49097Medicare UPIN