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General NPI Number Information
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NPI Number | 1669163390
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Entity Type | Individual
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Provider Name | JACOB MUSTO OD
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Gender | Male
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Dates
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Enumeration Date | 05/15/2023
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Last Update Date | 06/22/2025
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Provider Practice Location Address
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Address Line | 7171 S YALE AVE STE 103
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City | TULSA
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State | OK
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Zip | 74136-6367
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Country | US
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Telephone | 918-499-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 7171 S YALE AVE STE 103
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City | TULSA
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State | OK
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Zip | 74136-6367
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Country | US
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Telephone | 918-499-3937
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Fax |
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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 | 3234
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License Number State | OK
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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 | ATI4693
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License Number State | OR
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