Provider Demographics
NPI:1689049074
Name:DR. STEVE JACOBS, OPTOMETRIST
Entity Type:Organization
Organization Name:DR. STEVE JACOBS, OPTOMETRIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-953-0136
Mailing Address - Street 1:620 N MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-3385
Mailing Address - Country:US
Mailing Address - Phone:540-953-0136
Mailing Address - Fax:540-953-1358
Practice Address - Street 1:620 N MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-3385
Practice Address - Country:US
Practice Address - Phone:540-953-0136
Practice Address - Fax:540-953-1358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000267152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9202609Medicaid
VAU27990Medicare UPIN