Jacobson Optometry LTD

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

JACOBSON OPTOMETRY LTD

Practice address

1801 W Knapp St Ste 3
Rice Lake, WI 54868-1381

Phone

(715) 234-3113

Fax

(715) 234-2339

NPI assigned

Jan 28, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Kevin E Jacobson, O.D.

Title

Doctor

Phone

(715) 234-3113

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

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

{
    "created_epoch": "1201478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201478400000",
    "number": "1255518635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 W KNAPP ST STE 3",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548681381",
            "telephone_number": "715-234-3113",
            "fax_number": "715-234-2339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W KNAPP ST STE 3",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548681381",
            "telephone_number": "715-234-3113",
            "fax_number": "715-234-2339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACOBSON OPTOMETRY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-28",
        "last_updated": "2008-01-28",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "715-234-3113",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38527700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sean M. Inderbitzen, LCSW
• Inner Ascent Counseling LLC
• Interventional Pain Specialists of Wisconsin, SC
• Interventional Pain Specialists of Wisconsin, SC
• Jason W Isaacson, DDS
• Kevin E Jacobson, OD
• Victoria Marie Jansen
• Brooke Jarmusz, OTR/L
• Jeffery J. Anderegg M.D., S.C.
• Diana Jendro, PHARM D

• Clinic/Center in Rice Lake, WI
• Providers in Rice Lake, WI by specialty
• Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; 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.