Provider Demographics
NPI:1184166449
Name:JESSICA CROOKER, O.D., PLLC
Entity type:Organization
Organization Name:JESSICA CROOKER, O.D., PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CROOKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-545-0792
Mailing Address - Street 1:85 FRONT ST UNIT 81
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-1315
Mailing Address - Country:US
Mailing Address - Phone:781-545-0792
Mailing Address - Fax:781-545-4323
Practice Address - Street 1:85 FRONT ST UNIT 81
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-1315
Practice Address - Country:US
Practice Address - Phone:781-545-0792
Practice Address - Fax:781-545-4323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4949152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1184166449OtherGROUP NPI
MA1184166449OtherGROUP NPI