Provider Demographics
NPI:1043274954
Name:HAVEL, JEFFREY D (OD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:HAVEL
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 1:339 N ROUTE 73
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-9707
Mailing Address - Country:US
Mailing Address - Phone:856-753-1547
Mailing Address - Fax:610-825-5398
Practice Address - Street 1:339 N ROUTE 73
Practice Address - Street 2:SUITE 4
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9707
Practice Address - Country:US
Practice Address - Phone:856-753-1547
Practice Address - Fax:610-825-5398
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00601600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU75049Medicare UPIN