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General NPI Number Information
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NPI Number | 1043386287
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Entity Type | Organization
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Legal Business Name | DAVID A JACOBY OD CHARTERED
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 131 W MARKET ST STE A
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City | OSAGE CITY
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State | KS
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Zip | 66523
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Country | US
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Telephone | 785-528-4136
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Fax | 785-528-3422
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Provider Business Mailing Address
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Address Line | 131 W MARKET ST STE A
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City | OSAGE CITY
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State | KS
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Zip | 66523-1099
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Country | US
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Telephone | 620-803-8616
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JODY BULLER
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Credential |
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Telephone | 620-803-8616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 1171-3
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License Number State | KS
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