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General NPI Number Information
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NPI Number | 1811288020
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Entity Type | Organization
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Legal Business Name | JERRY S. JACOBS, O.D., P.C.
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Dates
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Enumeration Date | 04/21/2011
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Last Update Date | 09/01/2011
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Provider Practice Location Address
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Address Line | 1201 ELM ST STE LL20
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City | DALLAS
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State | TX
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Zip | 75270-2102
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Country | US
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Telephone | 214-651-1000
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Fax | 214-651-1003
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Provider Business Mailing Address
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Address Line | 1201 ELM ST STE. LL20
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City | DALLAS
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State | TX
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Zip | 75270-2102
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Country | US
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Telephone | 214-651-1000
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Fax | 214-651-1003
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. JERRY S JACOBS
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Credential | O.D.
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Telephone | 214-651-1000
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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 | 1781TG
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License Number State | TX
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