Jacqueline Rita De Jesse, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEGOO1547 Issued in PA

Practice address

4106 Edgmont Ave
Brookhaven, PA 19015-2314

Phone

(610) 872-8989

Fax

(610) 872-5220

NPI assigned

Oct 4, 2005

Last updated

Nov 25, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brookhaven Family Eye Care Center

  dba Brookhaven Vision Source

  • Optometrist
  • Brookhaven, PA
  • NPI 1760490494
  NPD
• Marguerite R Billbrough PC

  dba Center For Sight Of Delaware County

  • Ophthalmology Physician
  • Media, PA
  • NPI 1699786426
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227571200000",
    "number": "1164419115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4106 EDGMONT AVE",
            "city": "BROOKHAVEN",
            "state": "PA",
            "postal_code": "190152314",
            "telephone_number": "610-872-8989",
            "fax_number": "610-872-5220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4106 EDGMONT AVE",
            "city": "BROOKHAVEN",
            "state": "PA",
            "postal_code": "190152314",
            "telephone_number": "610-872-8989",
            "fax_number": "610-872-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE JESSE",
        "first_name": "JACQUELINE",
        "middle_name": "RITA",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-04",
        "last_updated": "2008-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEGOO1547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA NON-HMO",
            "identifier": "5704053",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "0055699",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005487270005",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUE CROSS",
            "identifier": "0062198000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "064195",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "442580095",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Brookhaven, PA
• Providers in Brookhaven, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.