Kevin Jacobs, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004013 Issued in MI

Practice address

1905 Abbot Rd Ste 1
East Lansing, MI 48823-8571

Phone

(517) 580-8733

Fax

(517) 337-1854

NPI assigned

May 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Zenvision

  • Optometrist
  • East Lansing, MI
  • NPI 1336602911
  Medicare reassignment NPD Authorized official
• Lansing Ophthalmology, P.C.

  • Ophthalmology Physician
  • East Lansing, MI
  • NPI 1962485342

  Optometrist

  NPD (past)
• Luxottica Retail North America Inc

  • Eyewear Supplier
  • Midland, MI
  • NPI 1053457101
  NPD (past)
• Luxottica of America Inc

  • Eyewear Supplier
  • Kansas City, MO
  • NPI 1497412522
  NPD (past)

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1801840657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 ABBOT RD STE 1",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488238571",
            "telephone_number": "517-580-8733",
            "fax_number": "517-337-1854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 ABBOT RD STE 1",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488238571",
            "telephone_number": "517-580-8733",
            "fax_number": "517-337-1854"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "139 W Lake Lansing Rd",
            "address_2": "Suite 115",
            "address_purpose": "LOCATION",
            "city": "East Lansing",
            "state": "MI",
            "postal_code": "488238525",
            "country_code": "US",
            "telephone_number": "517-337-1832",
            "fax_number": "517-337-1854",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "MI",
            "license": "4901004013",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "MI",
            "license": "4901004013",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "MI",
            "license": "4901004013",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP-MEDICAID",
            "identifier": "22-70122",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "86-4792288",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICANS HEALTH PLAN-PHP",
            "identifier": "22-00122",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "900C313100",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN",
            "identifier": "1019456",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "94-4318770",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anne Colleen Jack, LMSW
• Alexia Dominique Jackson, LAT, ATC
• Justice Jackson
• Monica Hicks Jackson
• Jacob Myers, DDS, PLLC
• David Jager, ATC. LAT
• Meera Jain
• Connor James
• Michael J. James, PSY.D., LP
• Nicole L Jamieson, NP

• Optometrist in East Lansing, MI
• Providers in East Lansing, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.