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General NPI Number Information
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NPI Number | 1952518748
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Entity Type | Organization
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Legal Business Name | SUBURBAN OPTOMETRICS ASSOC P C
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 32415 5 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48154-3039
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Country | US
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Telephone | 734-525-8170
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Fax | 734-525-0726
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Provider Business Mailing Address
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Address Line | 32415 5 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48154-3039
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Country | US
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Telephone | 734-525-8170
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Fax | 734-525-0726
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JOHN P JACOBI
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Credential | O.D., F.C.O.V.D.
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Telephone | 734-525-8170
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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 | 4901004024
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License Number State | MI
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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 | 4901003184
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 4901003184
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 4901003208
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901004851
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901003208
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License Number State | MI
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