Individual
JACQUELINE RITA DE JESSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
4106 EDGMONT AVE, BROOKHAVEN, PA 19015-2314
(610) 872-8989
(610) 872-5220
Mailing address
4106 EDGMONT AVE, BROOKHAVEN, PA 19015-2314
(610) 872-8989
(610) 872-5220
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEGOO1547
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005487270005
—
PA
01
—
0055699
AETNA HMO
PA
01
—
0062198000
INDEPENDENCE BLUE CROSS
PA
01
—
064195
HIGHMARK
PA
01
—
442580095
RAILROAD MEDICARE
PA
01
—
5704053
AETNA NON-HMO
PA
Enumeration date
10/04/2005
Last updated
11/25/2008
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