Individual
GARY J JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
9961 SIERRA AVE, FONTANA, CA 92335-6720
(909) 427-3910
Mailing address
9961 SIERRA AVE, FONTANA, CA 92335-6720
(909) 427-3910
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT6467TPA
CA
Other
Enumeration date
11/29/2006
Last updated
09/23/2008
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