Healthcare Provider Details

I. General information

NPI: 1538098264
Provider Name (Legal Business Name): REENA ALICE JACOB O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3497 STEELYARD DR
CLEVELAND OH
44109-2385
US

IV. Provider business mailing address

3485 AUVERGNE OVAL
BRUNSWICK OH
44212-3185
US

V. Phone/Fax

Practice location:
  • Phone: 216-706-1518
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.007482
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: