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General NPI Number Information
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NPI Number | 1144568288
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Entity Type | Organization
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Legal Business Name | JOHN Y JACOBS OD INC
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Dates
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Enumeration Date | 01/24/2013
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Last Update Date | 07/01/2013
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Provider Practice Location Address
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Address Line | 5657 WILSHIRE BLVD SUITE 130
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City | LOS ANGELES
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State | CA
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Zip | 90036-3736
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Country | US
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Telephone | 310-717-4901
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Fax |
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Provider Business Mailing Address
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Address Line | 5657 WILSHIRE BLVD SUITE 130
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City | LOS ANGELES
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State | CA
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Zip | 90036
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOHN JACOBS
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Credential |
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Telephone | 310-717-4901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 12983
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License Number State | CA
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