Provider Demographics
NPI:1831406396
Name:JACOBSON EYECARE, INC.
Entity type:Organization
Organization Name:JACOBSON EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-517-7190
Mailing Address - Street 1:245 BLOOMFIELD DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-7788
Mailing Address - Country:US
Mailing Address - Phone:717-517-5190
Mailing Address - Fax:717-517-7379
Practice Address - Street 1:245 BLOOMFIELD DR
Practice Address - Street 2:SUITE 108
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7788
Practice Address - Country:US
Practice Address - Phone:717-517-7190
Practice Address - Fax:717-517-7379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-06
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002450152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6528130001Medicare NSC