Provider Demographics
NPI:1942493234
Name:MOLL, JACOB PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:PAUL
Last Name:MOLL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3705 E JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-1858
Mailing Address - Country:US
Mailing Address - Phone:870-336-2452
Mailing Address - Fax:870-336-2455
Practice Address - Street 1:3705 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-1858
Practice Address - Country:US
Practice Address - Phone:870-336-2452
Practice Address - Fax:870-336-2455
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2591152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist