Provider Demographics
NPI:1689703308
Name:JACOBS, LAWRENCE L (OD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:L
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 1:8677 S. QUEBEC ST SUITE A
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-3052
Mailing Address - Country:US
Mailing Address - Phone:303-794-2020
Mailing Address - Fax:
Practice Address - Street 1:8677 S. QUEBEC ST SUITE A
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80130-3052
Practice Address - Country:US
Practice Address - Phone:303-794-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT 1478152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC800189Medicare ID - Type Unspecified
COU09106Medicare UPIN