Provider Demographics
NPI:1437212560
Name:JACOBI, JOHN PAUL (OD, FCOVD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:JACOBI
Suffix:
Gender:M
Credentials:OD, FCOVD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32415 5 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3039
Mailing Address - Country:US
Mailing Address - Phone:734-525-8170
Mailing Address - Fax:734-525-0726
Practice Address - Street 1:32415 5 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3039
Practice Address - Country:US
Practice Address - Phone:734-525-8170
Practice Address - Fax:734-525-0726
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003208152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU25782Medicare UPIN
MI0377500001Medicare NSC
MI0Q27636004Medicare ID - Type Unspecified