Provider Demographics
NPI:1376609636
Name:JACOBI-GARCIA, STACIA M (OD)
Entity Type:Individual
Prefix:DR
First Name:STACIA
Middle Name:M
Last Name:JACOBI-GARCIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7110 WYOMING BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4867
Mailing Address - Country:US
Mailing Address - Phone:505-883-8111
Mailing Address - Fax:505-888-8942
Practice Address - Street 1:7110 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4867
Practice Address - Country:US
Practice Address - Phone:505-883-8111
Practice Address - Fax:505-888-8942
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2562152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM222198OtherEYEMED COLE SUPERIOR
NM55144OtherDAVIS VISION