Individual
JACQUELINE HARTONO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
33 W 42ND ST, NEW YORK, NY 10036-8005
(212) 938-4001
Mailing address
725 METROPOLITAN AVE APT 4B, BROOKLYN, NY 11211-3875
(805) 990-4192
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV009616
NY
Other
Enumeration date
07/25/2022
Last updated
08/15/2022
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