Healthcare Provider Details

I. General information

NPI: 1619815800
Provider Name (Legal Business Name): GRACE LAUREN HAEMMERLE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 MAIN AVE
CLIFTON NJ
07011-2327
US

IV. Provider business mailing address

1016 MAIN AVE
CLIFTON NJ
07011-2327
US

V. Phone/Fax

Practice location:
  • Phone: 973-546-5700
  • Fax:
Mailing address:
  • Phone: 973-546-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00743400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: