NPIMap

Organization Active NPI

Leslie W. Jacobson, MD PA

  • Ophthalmology Physician
  • Edina, MN
National Provider Identifier
1376747808
Registry record updated Nov 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
14592 Issued in MN
Legal business name
LESLIE W. JACOBSON, MD PA
Practice address
6533 Drew Ave S
Edina, MN 55435-2103
Phone
(952) 927-7138
Fax
(952) 924-4021
NPI assigned
Jun 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2011

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

Authorized official

Name
Dr. Leslie Walter Jacobson, M.D.
Title
Dr
Phone
(952) 927-7138

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X 14592 MN Primary

Addresses

Primary practice location

6533 Drew Ave S
Edina, MN 55435-2103

Mailing address

6533 Drew Ave S
Edina, MN 55435-2103
Phone (952) 927-7138

Other identifiers 1

IdentifierTypeStateIssuer
767265900MedicaidMN

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322438400000",
    "number": "1376747808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6533 DREW AVE S",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352103",
            "telephone_number": "952-927-7138",
            "fax_number": "952-924-4021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6533 DREW AVE S",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352103",
            "telephone_number": "952-927-7138",
            "fax_number": "952-924-4021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LESLIE W. JACOBSON, MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-11",
        "last_updated": "2011-11-28",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "WALTER",
        "authorized_official_title_or_position": "DR",
        "authorized_official_telephone_number": "952-927-7138",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": "14592",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "767265900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.