Provider Demographics
NPI:1609951581
Name:GARCIA, DEBRA JACOBS (OD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:JACOBS
Last Name:GARCIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:DEBRA
Other - Middle Name:SUE
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 538
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530
Mailing Address - Country:US
Mailing Address - Phone:574-277-4927
Mailing Address - Fax:574-277-4967
Practice Address - Street 1:6501 N GRAPE RD
Practice Address - Street 2:SUITE 178
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545
Practice Address - Country:US
Practice Address - Phone:574-243-2384
Practice Address - Fax:574-243-2381
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002420152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN238830Medicare ID - Type Unspecified
T90471Medicare UPIN