Provider Demographics
NPI:1932173069
Name:JACO, JAMES DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DAVID
Last Name:JACO
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 1:106 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2015
Mailing Address - Country:US
Mailing Address - Phone:270-753-2842
Mailing Address - Fax:270-753-2844
Practice Address - Street 1:106 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2015
Practice Address - Country:US
Practice Address - Phone:270-753-2842
Practice Address - Fax:270-753-2844
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1292DT152W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY390064OtherHEALTHLINK
KYU52171OtherBLUEGRASS FAMILY HEALTH
KY000000690402OtherANTHEM BCBS
KY7594579OtherAETNA
KY77012920Medicaid
KY77012920Medicaid
KY6479350001Medicare NSC
KYP400034037Medicare PIN
KY77012920Medicaid