Provider Demographics
NPI:1780269969
Name:JACOBSEN, KRISTEN TAYLOR (OD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:TAYLOR
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:TAYLOR
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:306 MUIRS CHAPEL RD STE B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-6178
Mailing Address - Country:US
Mailing Address - Phone:336-854-0066
Mailing Address - Fax:336-252-1053
Practice Address - Street 1:306 MUIRS CHAPEL RD STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-6178
Practice Address - Country:US
Practice Address - Phone:336-854-0066
Practice Address - Fax:336-252-1053
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2639152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist