Provider Demographics
NPI:1376276386
Name:STROUS, JACOB ETHAN (OD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ETHAN
Last Name:STROUS
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 1:1132 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1511
Mailing Address - Country:US
Mailing Address - Phone:781-878-2300
Mailing Address - Fax:781-878-2382
Practice Address - Street 1:1132 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1511
Practice Address - Country:US
Practice Address - Phone:781-878-2300
Practice Address - Fax:781-878-2382
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6144152W00000X
MA5607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist