NPIMap

Organization Active NPI

Jacob Family Eyecare, LLC

  • Optometrist
  • Dry Ridge, KY
National Provider Identifier
1841681400
Registry record updated Feb 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1458DT Issued in KY
Legal business name
JACOB FAMILY EYECARE, LLC
Practice address
20 Ferguson Blvd
Dry Ridge, KY 41035-8635
Phone
(859) 824-1333
Fax
(859) 824-1300
NPI assigned
Feb 17, 2015
Last updated
Feb 17, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2015

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

Authorized official

Name
Dr. Kevin Sean Jacob, O.D.NPI 1124173521
Title
Owner/Optometrist
Phone
(859) 824-1333

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1452DT KY
Optometrist 152W00000X 1458DT KY Primary

Addresses

Primary practice location

20 Ferguson Blvd
Dry Ridge, KY 41035-8635

Mailing address

20 Ferguson Blvd
Dry Ridge, KY 41035-8635
Phone (859) 824-1333

Other identifiers 2

IdentifierTypeStateIssuer
77001535MedicaidKY
77001576MedicaidKY

National Provider Directory

National Provider Directory

Locations

20 Ferguson Blvd
Dry Ridge, KY 41035
Phone (859) 824-1333

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1424131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424131200000",
    "number": "1841681400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 FERGUSON BLVD",
            "city": "DRY RIDGE",
            "state": "KY",
            "postal_code": "410358635",
            "telephone_number": "859-824-1333",
            "fax_number": "859-824-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 FERGUSON BLVD",
            "city": "DRY RIDGE",
            "state": "KY",
            "postal_code": "410358635",
            "telephone_number": "859-824-1333",
            "fax_number": "859-824-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACOB FAMILY EYECARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-17",
        "last_updated": "2015-02-17",
        "status": "A",
        "authorized_official_last_name": "JACOB",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "SEAN",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "859-824-1333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1452DT",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1458DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77001535",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77001576",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dry Ridge, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2015; 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.