Provider Demographics
NPI:1043291511
Name:JACEY, ROBERT W (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:JACEY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 TRAIN LN
Mailing Address - Street 2:
Mailing Address - City:HEATHSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22473-4595
Mailing Address - Country:US
Mailing Address - Phone:804-517-5555
Mailing Address - Fax:804-737-9058
Practice Address - Street 1:712 TRAIN LN
Practice Address - Street 2:
Practice Address - City:HEATHSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22473-4595
Practice Address - Country:US
Practice Address - Phone:804-517-5555
Practice Address - Fax:804-737-9058
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101024617207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC03829OtherMEDICARE GROUP
VA006380069Medicaid
VA006380069Medicaid
VAB07981Medicare UPIN