Provider Demographics
NPI:1821196874
Name:KERSULEC-MORILLO, YVONNE E (OD)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:E
Last Name:KERSULEC-MORILLO
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 1:1386 ALPS RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3604
Mailing Address - Country:US
Mailing Address - Phone:973-628-0100
Mailing Address - Fax:973-628-0164
Practice Address - Street 1:1386 ALPS RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3604
Practice Address - Country:US
Practice Address - Phone:973-628-0100
Practice Address - Fax:973-628-0164
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00575800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJV03335Medicare UPIN