Active NPI
Gary Leonard Jacobs, OPTICIAN
- Optician
- Brooksville, FL
National Provider Identifier
1760690135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- DO3669
- Practice address
- 13132 Cortez Blvd
Brooksville, FL 34613-4858 - Phone
- (352) 597-0410
- Fax
- (352) 597-0420
- NPI assigned
- May 18, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Optician | 156FX1800X | DO3669 | FL | Primary |
Addresses
Primary practice location
13132 Cortez Blvd
Brooksville, FL 34613-4858
Mailing address
6316 Bayside Dr
New Port Richey, FL 34652-2038
Phone (727) 845-8112
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 |
|---|---|---|---|
| DO3669 | FL | MD | Optician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optimart, Inc. | Optician | Past | Accepting new patients |
| Optimart, Inc. | Optician | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760690135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6316 BAYSIDE DR",
"city": "NEW PORT RICHEY",
"state": "FL",
"postal_code": "346522038",
"telephone_number": "727-845-8112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13132 CORTEZ BLVD",
"city": "BROOKSVILLE",
"state": "FL",
"postal_code": "346134858",
"telephone_number": "352-597-0410",
"fax_number": "352-597-0420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "GARY",
"middle_name": "LEONARD",
"credential": "OPTICIAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "FL",
"license": "DO3669",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooksville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.