=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184422206
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACOB SAXON OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2025
-----------------------------------------------------
Last Update Date | 11/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1776 BROADWAY STE 1410
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-2007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-877-7188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 705
-----------------------------------------------------
City | LAKE HARMONY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18624-0705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-855-4875
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 011141
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------