David a Jacoby OD Chartered
Organization Active NPI Eyewear Supplier · Osage City, KS
NPI 1043386287 · NPPES record last updated Oct 15, 2025
Key facts
- NPI
- 1043386287
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Eyewear Supplier 332H00000X
- License
- 1171-3 (KS)
- Legal business name
- DAVID A JACOBY OD CHARTERED
- Practice address
- 131 W Market St Ste a
Osage City, KS 66523 - Phone
- (785) 528-4136
- Fax
- (785) 528-3422
- NPI assigned
- Nov 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Jody Buller
- Title
- President
- Phone
- (620) 803-8616
Practitioners 1
-
Jody Buller, O.D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| David a. Jacoby, O.D., Chartered |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100818001194 | KS | Part B Supplier - Clinic/Group Practice | 7517091044 |
Receives reassigned benefits from 1 practitioner Practice locations: Council Grove, KS; Osage City, KS |
| O20100930051320 | KS | DME Supplier - Physician - Optometrist | 7517091044 | Practice locations: Osage City, KS |
National Provider Directory
Locations
613 Market St
Osage City, KS 66523
Phone (785) 528-4136
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Eyewear Supplier | 332H00000X | 1171-3 | KS | Yes |
Addresses
Primary practice location
131 W Market St Ste a
Osage City, KS 66523
Mailing address
131 W Market St Ste a
Osage City, KS 66523-1099
Phone (620) 803-8616
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30004700180001 | Medicaid | KS |
Other providers in Osage City, KS
- Jenny Ann Bowin
- Lindsey R Buckman
- Sherri L Coffman
- Su Colstrom
- CPF Senior Living - Osage City LLC
- Amber Marie Delmott
- Mandy R Gibson
- William J Grace
- Patricia Kay Gundy
- Carrie A. Hagemann
All providers in Osage City, KS · Eyewear Supplier in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.