MEDICARE: DR. KRISTEN TAYLOR JACOBSEN OD

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	2639	NC

General Provider Information

NPI Number	:	1780269969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN TAYLOR JACOBSEN OD

Provider Business Mailing Address
First Line	:	306 MUIRS CHAPEL RD STE B
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-6178
Country	:	US
Telephone Number	:	336-854-0066
Fax Number	:	336-252-1053

Provider Business Practice Location Address
First Line	:	306 MUIRS CHAPEL RD STE B
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-6178
Country	:	US
Telephone Number	:	336-854-0066
Fax Number	:	336-252-1053

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

Provider Enumeration Date	:	03/10/2021
Last Update Date	:	08/07/2023

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