Provider Demographics
NPI:1467489955
Name:JACOBS, DONALD S (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:S
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 CEI DRIVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3311
Mailing Address - Country:US
Mailing Address - Phone:513-569-3741
Mailing Address - Fax:513-569-3941
Practice Address - Street 1:1945 CEI DRIVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-3311
Practice Address - Country:US
Practice Address - Phone:513-569-3741
Practice Address - Fax:513-569-3941
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-1858207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20020310Medicaid
KY64781982Medicaid
OH0363280Medicaid
OH000000021131OtherBCBS
IN20020310Medicaid
OH0363280Medicaid