Mark Jacobs OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

NC1366 Issued in NC

Legal business name

MARK JACOBS OD PA

Practice address

300 Julian LN
Arden, NC 28704-7809

Phone

(828) 650-2727

Fax

(828) 650-2725

NPI assigned

Feb 6, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark E Jacobs, ODNPI 1457392466

Title

President Optometrist

Phone

(828) 650-2727

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Edward Jacobs, OD

  • Optometrist
  • Arden, NC
  • NPI 1457392466
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607644800000",
    "number": "1114105608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 JULIAN LN",
            "city": "ARDEN",
            "state": "NC",
            "postal_code": "287047809",
            "telephone_number": "828-650-2727",
            "fax_number": "828-650-2725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 JULIAN LN",
            "city": "ARDEN",
            "state": "NC",
            "postal_code": "287047809",
            "telephone_number": "828-650-2727",
            "fax_number": "828-650-2725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK JACOBS OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-06",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-07",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT OPTOMETRIST",
        "authorized_official_telephone_number": "828-650-2727",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NC",
            "license": "NC1366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Arden, NC
• Providers in Arden, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.