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General NPI Number Information
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NPI Number | 1689049074
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Entity Type | Organization
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Legal Business Name | DR. STEVE JACOBS, OPTOMETRIST
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 12/10/2015
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Provider Practice Location Address
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Address Line | 620 N MAIN ST SUITE 101
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City | BLACKSBURG
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State | VA
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Zip | 24060-3385
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Country | US
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Telephone | 540-953-0136
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Fax | 540-953-1358
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Provider Business Mailing Address
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Address Line | 620 N MAIN ST SUITE 101
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City | BLACKSBURG
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State | VA
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Zip | 24060-3385
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Country | US
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Telephone | 540-953-0136
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Fax | 540-953-1358
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. STEVE JACOBS
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Credential | O.D.
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Telephone | 540-953-0136
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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 | 0618000267
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License Number State | VA
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