Provider Demographics
NPI:1831224708
Name:HERSCH, JOEL N (OD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:N
Last Name:HERSCH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 MILITARY TRL STE 101
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7009
Mailing Address - Country:US
Mailing Address - Phone:561-575-4616
Mailing Address - Fax:561-575-4936
Practice Address - Street 1:935 MILITARY TRL STE 101
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7009
Practice Address - Country:US
Practice Address - Phone:561-575-4616
Practice Address - Fax:561-575-4936
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1928152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65-0081302OtherFEDERAL TAX I.D. #
FL20079BMedicare PIN
FL65-0081302OtherFEDERAL TAX I.D. #