Provider Demographics
NPI:1972684405
Name:JACOBSON, ALLYN HOWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLYN
Middle Name:HOWARD
Last Name:JACOBSON
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 1:9529 SW 160TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-3350
Mailing Address - Country:US
Mailing Address - Phone:305-238-2121
Mailing Address - Fax:305-238-2123
Practice Address - Street 1:9529 SW 160TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-3350
Practice Address - Country:US
Practice Address - Phone:305-238-2121
Practice Address - Fax:305-238-2123
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1033152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084493400Medicaid
FL084493400Medicaid
FL19652Medicare ID - Type Unspecified