Provider Demographics
NPI:1720209075
Name:LEE R JACOBSON
Entity Type:Organization
Organization Name:LEE R JACOBSON
Other - Org Name:JACOBSON ADVANCED EYE CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JACOBSON
Authorized Official - Last Name:TURCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-327-8239
Mailing Address - Street 1:PO BOX 630
Mailing Address - Street 2:
Mailing Address - City:FREDERIC
Mailing Address - State:WI
Mailing Address - Zip Code:54837-0630
Mailing Address - Country:US
Mailing Address - Phone:715-327-8239
Mailing Address - Fax:715-327-8252
Practice Address - Street 1:108 OAK ST E
Practice Address - Street 2:
Practice Address - City:FREDERIC
Practice Address - State:WI
Practice Address - Zip Code:54837-9574
Practice Address - Country:US
Practice Address - Phone:715-327-8239
Practice Address - Fax:715-327-8252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier