Individual
MATTHEW JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 E ALICE ST, BAINBRIDGE, GA 39819-4998
(630) 485-1369
Mailing address
3380 FRED GEORGE RD APT 704, TALLAHASSEE, FL 32303-1503
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT003026
GA
Other
Enumeration date
06/21/2017
Last updated
06/21/2017
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