Kevin Sean Jacob, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1458DT Issued in KY

Practice address

20 Ferguson Blvd
Dry Ridge, KY 41035-8635

Phone

(859) 824-1333

NPI assigned

Jan 24, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Indiana University - School of Optometry, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572825600000",
    "number": "1124173521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9100 BRANTLEY WAY",
            "city": "FLORENCE",
            "state": "KY",
            "postal_code": "410428684",
            "telephone_number": "859-384-7646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 FERGUSON BLVD",
            "city": "DRY RIDGE",
            "state": "KY",
            "postal_code": "410358635",
            "telephone_number": "859-824-1333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Heights Blvd",
            "address_purpose": "LOCATION",
            "city": "Florence",
            "state": "KY",
            "postal_code": "410421415",
            "country_code": "US",
            "telephone_number": "859-568-7015",
            "fax_number": "859-568-7016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOB",
        "first_name": "KEVIN",
        "middle_name": "SEAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-24",
        "last_updated": "2019-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1458DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77001535",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHA",
            "identifier": "000001186679",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000255312",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• J & M Medical, LLC
• Jacob Family Eyecare, LLC
• Stephanie Jacob, O.D.
• Jennifer L Meek DMD PLLC
• Jody Elaine Keeley
• Livewell Gastroenterology, PLLC
• Gina Lowe, LDO

• Optometrist in Dry Ridge, KY
• Providers in Dry Ridge, KY by specialty
• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.