Bruce Robert Jacobson, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

35048289 Issued in OH

Practice address

36100 Euclid Ave
Suite 450
Willoughby, OH 44094-4456

Phone

(440) 946-9555

Fax

(440) 946-2223

NPI assigned

Dec 15, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• University Hospitals Medical Group Inc

  • Multi-Specialty Clinic/Center
  • Cleveland, OH
  • NPI 1669499414

  Ophthalmology

  NPD (past)

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

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393459200000",
    "number": "1760467484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2561 LANDER RD",
            "city": "PEPPER PIKE",
            "state": "OH",
            "postal_code": "441244317",
            "telephone_number": "440-461-5666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36100 EUCLID AVE",
            "address_2": "SUITE 450",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944456",
            "telephone_number": "440-946-9555",
            "fax_number": "440-946-2223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "BRUCE",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2014-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "OH",
            "license": "35048289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0602351",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J. Michael Vento, M.D.
• Jack Anstandig, M.D., Inc.
• Kim Yvette Jackson, LPN
• Latoiya Talisha Jackson, LPN
• Traci Jackson
• David Jacobson Jr., PA
• Neil A Jacobson, MD
• Jamal Azem, M.D., Inc
• James C. Trouten, D.D.S., M.S., Inc.
• Christopher Campbell James, D.O

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 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.

Verify at the official NPI Registry.