Provider Demographics
NPI:1225227986
Name:JACOBS EYE CENTER, LTD.
Entity Type:Organization
Organization Name:JACOBS EYE CENTER, LTD.
Other - Org Name:ANNE JACOBS MD LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-272-2663
Mailing Address - Street 1:5883 HICKORY TRL
Mailing Address - Street 2:
Mailing Address - City:N RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-2650
Mailing Address - Country:US
Mailing Address - Phone:216-272-2663
Mailing Address - Fax:
Practice Address - Street 1:37500 HARVEST AVE
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-2804
Practice Address - Country:US
Practice Address - Phone:440-934-2750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0632088Medicaid
OH351601OtherWELLCARE
OH4459330001Medicare NSC
OH0888912Medicare PIN