MEDICARE: TANYA JACOBSON, OD., LLC

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	TUV005630-1	NY

General Provider Information

NPI Number	:	1669401394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TANYA JACOBSON, OD., LLC

Provider Business Mailing Address
First Line	:	535 CROWN ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-5126
Country	:	US
Telephone Number	:	917-854-2430
Fax Number	:

Provider Business Practice Location Address
First Line	:	379 KNICKERBOCKER AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-3701
Country	:	US
Telephone Number	:	718-418-1268
Fax Number	:

Authorized Official
Title or Position	:	PROPRIETOR
Name	:	DR. TANYA DINA JACOBSON
Credential	:	O.D.
Telephone Number	:	917-854-2430

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	08/22/2020

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