Provider Demographics
NPI:1033115779
Name:JACOBS, STEVE E (OD)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:E
Last Name:JACOBS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N MAIN ST
Mailing Address - Street 2:STE 101
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-3385
Mailing Address - Country:US
Mailing Address - Phone:540-953-0136
Mailing Address - Fax:540-953-1358
Practice Address - Street 1:620 N MAIN ST
Practice Address - Street 2:STE 101
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-3385
Practice Address - Country:US
Practice Address - Phone:540-953-0136
Practice Address - Fax:540-953-1358
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000267152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA410031149OtherRAILCAND MEDICARE
VA009202609Medicaid
VA085491OtherBCBS
VA410031149OtherRAILCAND MEDICARE
U27990Medicare UPIN
VA085491OtherBCBS