MEDICARE: DR. ERIN MICHELLE JACOB O.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	7279T	TX

General Provider Information

NPI Number	:	1316102692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIN MICHELLE JACOB O.D

Provider Business Mailing Address
First Line	:	1001 W SAN ANTONIO ST
Second Line	:
City	:	LOCKHART
State	:	TX
Zip	:	78644-2421
Country	:	US
Telephone Number	:	512-398-7600
Fax Number	:	512-398-3333

Provider Business Practice Location Address
First Line	:	1001 W SAN ANTONIO ST
Second Line	:
City	:	LOCKHART
State	:	TX
Zip	:	78644-2421
Country	:	US
Telephone Number	:	512-398-7600
Fax Number	:	512-398-3333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2008
Last Update Date	:	01/12/2011

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