Provider Demographics
NPI:1558525089
Name:FRANK, JACOB THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:THOMAS
Last Name:FRANK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:625 S COBB ST
Mailing Address - Street 2:STE. 101
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6480
Mailing Address - Country:US
Mailing Address - Phone:907-745-2273
Mailing Address - Fax:907-745-2312
Practice Address - Street 1:625 S COBB ST
Practice Address - Street 2:STE. 101
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6480
Practice Address - Country:US
Practice Address - Phone:907-745-2273
Practice Address - Fax:907-745-2312
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK298152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1023206Medicaid
AKK163168Medicare PIN