Provider Demographics
NPI:1710275995
Name:CROOKER, JESSICA MARIE (MS, OD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARIE
Last Name:CROOKER
Suffix:
Gender:F
Credentials:MS, OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 FRONT ST
Mailing Address - Street 2:UNIT 81
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-1315
Mailing Address - Country:US
Mailing Address - Phone:781-690-3737
Mailing Address - Fax:
Practice Address - Street 1:85 FRONT ST
Practice Address - Street 2:UNIT 81
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-1315
Practice Address - Country:US
Practice Address - Phone:781-690-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2835152W00000X
MA4949152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAD400058756Medicare PIN