MEDICARE: DR. REENA ALICE 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	OPT.007482	OH

General Provider Information

NPI Number	:	1538098264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REENA ALICE JACOB O.D.

Provider Business Mailing Address
First Line	:	3485 AUVERGNE OVAL
Second Line	:
City	:	BRUNSWICK
State	:	OH
Zip	:	44212-3185
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3497 STEELYARD DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-2385
Country	:	US
Telephone Number	:	216-706-1518
Fax Number	:

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

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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