Healthcare Provider Details

I. General information

NPI: 1538389846
Provider Name (Legal Business Name): LEE R JACOBSON OD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 SECOND AVE
CUMBERLAND WI
54829
US

IV. Provider business mailing address

PO BOX 250
CUMBERLAND WI
54829-0250
US

V. Phone/Fax

Practice location:
  • Phone: 715-822-2091
  • Fax: 715-822-3624
Mailing address:
  • Phone: 715-822-2091
  • Fax: 715-822-3624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER JACOBSON TURCOTT
Title or Position: OWNER
Credential: O.D.
Phone: 715-822-2091