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General NPI Number Information
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NPI Number | 1194731232
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Entity Type | Individual
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Provider Name | STEVEN VERGIL JACOBSEN OD
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 04/19/2012
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Provider Practice Location Address
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Address Line | 1445 N BELL ST
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City | FREMONT
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State | NE
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Zip | 68025-3534
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Country | US
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Telephone | 402-727-9220
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Fax | 402-727-5625
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Provider Business Mailing Address
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Address Line | PO BOX 72
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City | FREMONT
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State | NE
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Zip | 68026-0072
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Country | US
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Telephone | 402-727-9220
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Fax | 402-727-5625
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 780
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 01542
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License Number State | IA
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