Provider Demographics
NPI:1780099317
Name:ROCKMAN, JAKE (OD)
Entity type:Individual
Prefix:DR
First Name:JAKE
Middle Name:
Last Name:ROCKMAN
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 1:4101 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9310
Mailing Address - Country:US
Mailing Address - Phone:239-335-1944
Mailing Address - Fax:239-939-1575
Practice Address - Street 1:877 111TH AVE N STE 2
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1853
Practice Address - Country:US
Practice Address - Phone:239-591-2949
Practice Address - Fax:239-254-1921
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4923152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL190MBOtherBCBS
FL4021796OtherAETNA
FL013605300Medicaid
FL013605300Medicaid