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General NPI Number Information
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NPI Number | 1316127095
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Entity Type | Organization
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Legal Business Name | EDWARD R JACOBS OD PC
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 999 RIVERVIEW DR SUITE 203
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City | TOTOWA
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State | NJ
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Zip | 07512-1164
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Country | US
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Telephone | 973-785-4499
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Fax | 973-785-4699
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Provider Business Mailing Address
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Address Line | 999 RIVERVIEW DR SUITE 203
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City | TOTOWA
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State | NJ
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Zip | 07512-1164
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Country | US
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Telephone | 973-785-4499
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Fax | 973-785-4699
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD R JACOBS
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Credential | O.D. P.C.
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Telephone | 973-785-4499
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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 |
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License Number State |
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