Provider Demographics
NPI:1003811761
Name:JACOBY, DAVID A (DOCTOR OF OPTOMETRY)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:JACOBY
Suffix:
Gender:M
Credentials:DOCTOR OF OPTOMETRY
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 258
Mailing Address - Street 2:
Mailing Address - City:OSAGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66523-0258
Mailing Address - Country:US
Mailing Address - Phone:785-528-4136
Mailing Address - Fax:785-528-3422
Practice Address - Street 1:131 W MARKET ST STE A
Practice Address - Street 2:
Practice Address - City:OSAGE CITY
Practice Address - State:KS
Practice Address - Zip Code:66523-1099
Practice Address - Country:US
Practice Address - Phone:785-528-4136
Practice Address - Fax:785-528-3422
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1171-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1003811761Medicaid
KS1003811761Medicaid