Provider Demographics
NPI:1619943347
Name:JACOBS, PAUL C (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:JACOBS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7225 W HIGHWAY 71
Mailing Address - Street 2:SUITE B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8350
Mailing Address - Country:US
Mailing Address - Phone:512-892-1864
Mailing Address - Fax:512-892-1840
Practice Address - Street 1:7225 W HIGHWAY 71
Practice Address - Street 2:SUITE B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8350
Practice Address - Country:US
Practice Address - Phone:512-892-1864
Practice Address - Fax:512-892-1840
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03806T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU57397Medicare UPIN
TX611974Medicare ID - Type UnspecifiedMEDICARE ID