Lee R Jacobson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1298 Issued in WI

Practice address

1357 2ND Ave
Cumberland, WI 54829-7211

Phone

(715) 822-2091

Fax

(715) 822-3624

NPI assigned

Jul 21, 2005

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lee R Jacobson

  • Eyewear Supplier
  • Frederic, WI
  • NPI 1720209075
  NPD (past)
• Lee R Jacobson OD SC

  • Eyewear Supplier
  • Cumberland, WI
  • NPI 1538389846
  NPD (past)
• Lee R Jacobson OD SC

  • Optometrist
  • Cumberland, WI
  • NPI 1750494449
  NPD (past)
• St Croix Falls Eye Associates Inc.

  • Optometrist
  • Frederic, WI
  • NPI 1669585352
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 14, 2009.

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260748800000",
    "number": "1386644284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1357 2ND AVE",
            "city": "CUMBERLAND",
            "state": "WI",
            "postal_code": "548297211",
            "telephone_number": "715-822-2091",
            "fax_number": "715-822-3624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1357 2ND AVE",
            "city": "CUMBERLAND",
            "state": "WI",
            "postal_code": "548297211",
            "telephone_number": "715-822-2091",
            "fax_number": "715-822-3624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "LEE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-21",
        "last_updated": "2009-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "1298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38541900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR-PTAN 410011362",
            "identifier": "410011362",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR-PTAN 410040506",
            "identifier": "410040506",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Cumberland, WI
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2009; 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.