Jacob Paul Brucker II, DO

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

012274 Issued in AZ

Practice address

2145 N Fairfield Rd Ste 100
Beavercreek, OH 45431-2783

Phone

(937) 558-3900

Fax

(937) 558-3999

NPI assigned

Mar 24, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1648080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779148800000",
    "number": "1457001489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2145 N FAIRFIELD RD STE 100",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454312783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2145 N FAIRFIELD RD STE 100",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454312783",
            "telephone_number": "937-558-3900",
            "fax_number": "937-558-3999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCKER",
        "first_name": "JACOB",
        "middle_name": "PAUL",
        "name_suffix": "II",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-24",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "AZ",
            "license": "012274",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "OH",
            "license": "58.032632",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leonor Brown, O.T.R.
• Lilian Brown
• Courtney Amanda Browne
• Melissa Broyles
• Bruce E. Kline PSYD & Associates
• Gina Marie Brummett, HIS
• Bryan Dodd DDS, Inc. (Dodd, Jones, Rose Dental)
• Alex Michael Buchkovich
• Buckeye Behavior Services, LLC.
• Buckeye Behavioral Consulting Inc

• Ophthalmology Physician in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• Ophthalmology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2026; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.