Provider Demographics
NPI:1902841984
Name:STEVENS, JENNIFER ERNESTINE (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ERNESTINE
Last Name:STEVENS
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 1:2 SWEETFERN RD
Mailing Address - Street 2:
Mailing Address - City:STOCKHOLM
Mailing Address - State:NJ
Mailing Address - Zip Code:07460-1502
Mailing Address - Country:US
Mailing Address - Phone:270-570-3102
Mailing Address - Fax:
Practice Address - Street 1:5746 BERKSHIRE VLY RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07438-9847
Practice Address - Country:US
Practice Address - Phone:973-697-4550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008044152W00000X
PAOEG001625152W00000X
NJ27OA00599100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA410049675OtherRAILROAD MEDICARE
PA101564129Medicaid
PA101564129Medicaid
PA410049675OtherRAILROAD MEDICARE
PA5684740001Medicare NSC