Provider Demographics
NPI:1568631729
Name:JON S JACOBS OD PA
Entity Type:Organization
Organization Name:JON S JACOBS OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:S
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:OD,
Authorized Official - Phone:954-581-5400
Mailing Address - Street 1:1085 SUNSET STRIP
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6105
Mailing Address - Country:US
Mailing Address - Phone:954-581-5400
Mailing Address - Fax:954-581-5496
Practice Address - Street 1:1085 SUNSET STRIP
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33313-6105
Practice Address - Country:US
Practice Address - Phone:954-581-5400
Practice Address - Fax:954-581-5496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC951152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDP8124Medicare PIN
FLU82477Medicare UPIN
FLT83988Medicare UPIN
FLAJ850Medicare PIN