Provider Demographics
NPI:1801570288
Name:JACOBSEN, ALAINA (OD)
Entity type:Individual
Prefix:
First Name:ALAINA
Middle Name:
Last Name:JACOBSEN
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1714
Mailing Address - Country:US
Mailing Address - Phone:303-772-3611
Mailing Address - Fax:
Practice Address - Street 1:205 S MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1714
Practice Address - Country:US
Practice Address - Phone:303-772-3611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0004006152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty