MEDICARE: JABEKA INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1856T	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DO9351	OTHER	OR	RAILROAD MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3021	OTHER	OR	NORTHWEST BENEFIT NETWORK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	02501-01	OTHER	OR	PACIFIC SOURCE
5	049169002	OTHER	OR	BLUE CROSS
6	111228	OTHER	OR	EYEMED

General Provider Information

NPI Number	:	1881667160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JABEKA INC.

Provider Business Mailing Address
First Line	:	65 DIVISION AVE
Second Line	:	SUITE E
City	:	EUGENE
State	:	OR
Zip	:	97404-2485
Country	:	US
Telephone Number	:	541-689-1115
Fax Number	:	541-688-5585

Provider Business Practice Location Address
First Line	:	65 DIVISION AVE
Second Line	:	SUITE E
City	:	EUGENE
State	:	OR
Zip	:	97404-2485
Country	:	US
Telephone Number	:	541-689-1115
Fax Number	:	541-688-5585

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL LACKMAN
Credential	:	O.D.
Telephone Number	:	541-689-1115

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	09/28/2011

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Directions to “JABEKA INC. ” Practice Location

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