Provider Demographics
NPI:1447411228
Name:PINNACLE EYECARE, P.C.
Entity Type:Organization
Organization Name:PINNACLE EYECARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-337-1832
Mailing Address - Street 1:139 W LAKE LANSING RD STE 115
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8525
Mailing Address - Country:US
Mailing Address - Phone:517-337-1832
Mailing Address - Fax:517-337-1854
Practice Address - Street 1:139 W LAKE LANSING RD STE 115
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8525
Practice Address - Country:US
Practice Address - Phone:517-337-1832
Practice Address - Fax:517-337-1854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004013152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900C313100OtherBCBS
MI1019456OtherMCLAREN
MI200000002155OtherPHPMM
MI5658590001OtherMEDICARE DME
MI864792288Medicaid
MI944753842Medicaid
MIU79156Medicare UPIN