Gary D Jacobsen, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

453 Issued in MT

Practice address

3111 W Chandler Blvd
Suite 2104
Chandler, AZ 85226-5071

Phone

(480) 726-7009

NPI assigned

Nov 2, 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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Frances Mahon Deaconess Hospital

  • Critical Access Hospital
  • Glasgow, MT
  • NPI 1689685323
  NPD (past)

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391817600000",
    "number": "1891786513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3468 E HAZELTINE WAY",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852499167",
            "telephone_number": "406-939-1309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 W CHANDLER BLVD",
            "address_2": "SUITE 2104",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852265071",
            "telephone_number": "480-726-7009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSEN",
        "first_name": "GARY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2014-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MT",
            "license": "453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0480350",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "011003936",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shakara Shirose Jackson
• Stephanie Ann Jackson, DO
• Terry Jackson
• Richard Douglas Jacobs Jr., M.D.
• Suzanne K. Jacobs, LCSW
• Tricia Jacobson-Rudd, LASAC
• Katrina Frances Jacques
• Nicole Ndayishimiye Jacques
• Gita Jafari-Raske, MD
• Tania Jafary, M.D

• Optometrist in Chandler, AZ
• Providers in Chandler, AZ by specialty
• Optometrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 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.