Active NPI
Alan Jacobs, O.D.
- Optometrist
- Indio, CA
National Provider Identifier
1588071740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 05702
- Practice address
- 82227 US Highway 111
Ste B2
Indio, CA 92201-5667 - Phone
- (760) 347-6636
- Fax
- (760) 342-5987
- NPI assigned
- Jul 18, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 05702 | CA | Primary |
Addresses
Primary practice location
82227 US Highway 111
Ste B2
Indio, CA 92201-5667
Mailing address
82227 US Highway 111
Ste B2
Indio, CA 92201-5667
Phone (760) 347-6636
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05702 | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405641600000",
"number": "1588071740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "82227 US HIGHWAY 111",
"address_2": "STE B2",
"city": "INDIO",
"state": "CA",
"postal_code": "922015667",
"telephone_number": "760-347-6636",
"fax_number": "760-342-5987"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "82227 US HIGHWAY 111",
"address_2": "STE B2",
"city": "INDIO",
"state": "CA",
"postal_code": "922015667",
"telephone_number": "760-347-6636",
"fax_number": "760-342-5987"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "ALAN",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-18",
"last_updated": "2014-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "05702",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indio, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.