Individual
DR. MARK A JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3810 S HIGHWAY 27, SUITE 1, SOMERSET, KY 42501-3073
(606) 678-4551
(606) 678-0972
Mailing address
PO BOX 306, FERGUSON, KY 42533-0306
(606) 492-2211
(606) 676-0873
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1201DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00160523
AMERIGROUP
—
01
—
127554
BCBSTN/BLUECARE/TENNCARE
—
01
—
380000269
RAILROAD MEDICARE
KY
01
—
410028407
RAILROAD MEDICARE
KY
05
—
4599154
—
TN
05
—
7100209960
—
KY
05
—
7100209970
—
KY
05
—
77012011
—
KY
Enumeration date
06/17/2005
Last updated
12/03/2019
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