Individual
DR. RICHARD Y JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1428 2ND AVE N, MEDICAL ARTS BLDG, FORT DODGE, IA 50501-4119
(515) 573-1145
(515) 573-1028
Mailing address
1428 2ND AVE N, MEDICAL ARTS BLDG, FORT DODGE, IA 50501-4119
(515) 573-1145
(515) 573-1028
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1536
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07134
BC/BS
IA
05
—
3066183
—
IA
01
—
IB1233001
MEDICARE ID - TYPE UNSPECIFIED
IA
Enumeration date
01/04/2006
Last updated
02/25/2015
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