Organization
DAVID A JACOBY OD CHARTERED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODY BULLER (PRESIDENT)
(620) 803-8616
Entity
Organization
Contact information
Practice address
131 W MARKET ST STE A, OSAGE CITY, KS 66523
(785) 528-4136
(785) 528-3422
Mailing address
131 W MARKET ST STE A, OSAGE CITY, KS 66523-1099
(620) 803-8616
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
1171-3
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30004700180001
—
KS
Enumeration date
11/28/2006
Last updated
10/15/2025
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