Provider Demographics
NPI:1902888035
Name:AGNESS, DENISE A (OD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:AGNESS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 WHITEHORSE HAMILTON SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON SQUARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3536
Mailing Address - Country:US
Mailing Address - Phone:609-587-2020
Mailing Address - Fax:609-588-9545
Practice Address - Street 1:1700 WHITEHORSE HAMILTON SQUARE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08690-3536
Practice Address - Country:US
Practice Address - Phone:609-587-2020
Practice Address - Fax:609-588-9545
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA04471152W00000X
NJTO00324152WV0400X
NJ27OA00032400156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
F09963OtherHEALTHNET
NJ4471OtherEYEMED
P790045OtherOXFORD
0104605000OtherAMERIHEALTH
1049028OtherAETNA
334892OtherONE HEALTH PLAN
1088568OtherHORIZON NJ HEALTH
1821436OtherUNITED HEALTH CARE
25425OtherMASTERCARE
C47961OtherWELLCHOICE
0104605000OtherKEYSTONE
0720811006OtherCIGNA
NJ0897906Medicaid
NJ0897906Medicaid
U26661Medicare UPIN
NJ453617YJCXMedicare PIN