Provider Demographics
NPI:1821061839
Name:ROCKE, JILL W (OD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:W
Last Name:ROCKE
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 1:17 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3508
Mailing Address - Country:US
Mailing Address - Phone:201-894-1400
Mailing Address - Fax:201-894-0220
Practice Address - Street 1:17 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3508
Practice Address - Country:US
Practice Address - Phone:201-894-1400
Practice Address - Fax:201-894-0220
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00475900152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU82487Medicare UPIN
NJ043370Medicare ID - Type Unspecified