Provider Demographics
NPI:1760456651
Name:DAMICO, JENNIFER (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:DAMICO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:DAMICO
Other - Last Name:OCONNOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:355 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01535
Mailing Address - Country:US
Mailing Address - Phone:508-867-3755
Mailing Address - Fax:
Practice Address - Street 1:355 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01535
Practice Address - Country:US
Practice Address - Phone:508-867-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
981690OtherNETWORK HEALTH
MAW21011OtherBCBS - GROUP #
0392022OtherMASS HEALTH UNISYS
151329OtherHARVARD PILGRIM
2634580OtherAETNA
57106OtherTRICARE
W21011OtherMEDICARE C&S ADMIN SVCS
MA0392022Medicaid
20798OtherCIGNA HEALTHCARE
2203040OtherUNITED HEALTHCARE
2634580OtherAETNA HEALTH INC
747176OtherCONNECTICARE INC
9777385OtherMASS HEALTH UNISYS
1149190002OtherDMERC METRA HEALTH
732547OtherTUFTS ASSOC HEALTH PLAN
W15940OtherBLUE CROSS BLUE SHIELD MA
200OtherULTRA BENEFITS
W15940OtherMEDICARE C&S ADMIN SVCS
20798OtherCIGNA HEALTHCARE
W15940OtherBLUE CROSS BLUE SHIELD MA