Provider Demographics
NPI:1134196777
Name:BAKKER, KERRI ELIZABETH (OD)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:ELIZABETH
Last Name:BAKKER
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 1:13 KEDRON AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:PA
Mailing Address - Zip Code:19070-1513
Mailing Address - Country:US
Mailing Address - Phone:484-478-8000
Mailing Address - Fax:
Practice Address - Street 1:13 KEDRON AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:PA
Practice Address - Zip Code:19070-1513
Practice Address - Country:US
Practice Address - Phone:484-478-8000
Practice Address - Fax:484-478-8050
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001691152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770634OtherBLUE SHIELD
PA094240QCGMedicare ID - Type Unspecified
V06390Medicare UPIN
V06390Medicare UPIN