Provider Demographics
NPI:1407869340
Name:JACOBS, JERRY S (OD PC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:S
Last Name:JACOBS
Suffix:
Gender:M
Credentials:OD PC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:400 S ZANG BLVD
Mailing Address - Street 2:STE 804
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-6643
Mailing Address - Country:US
Mailing Address - Phone:214-941-8923
Mailing Address - Fax:214-941-4887
Practice Address - Street 1:400 S ZANG BLVD
Practice Address - Street 2:STE 804
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-6643
Practice Address - Country:US
Practice Address - Phone:214-941-8923
Practice Address - Fax:214-941-4887
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1781TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E22COtherBLUE CROSS BLUE SHIELD
TX00E22COtherBLUE CROSS BLUE SHIELD
TX0790550001Medicare NSC