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General NPI Number Information
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NPI Number | 1699516898
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Entity Type | Individual
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Provider Name | JACOB DANIEL LOCK OD
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Gender | Male
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 4377 WOODBINE RD
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City | PACE
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State | FL
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Zip | 32571-8792
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Country | US
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Telephone | 850-995-4555
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Fax | 850-995-4556
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Provider Business Mailing Address
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Address Line | 460 E NINE MILE RD
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City | PENSACOLA
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State | FL
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Zip | 32514-1441
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Country | US
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Telephone | 850-477-1499
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Fax | 850-479-3359
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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 | OPC6464
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License Number State | FL
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