Individual
DR. KEVIN SEAN JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
20 FERGUSON BLVD, DRY RIDGE, KY 41035-8635
(859) 824-1333
Mailing address
9100 BRANTLEY WAY, FLORENCE, KY 41042-8684
(859) 384-7646
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1458DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000255312
ANTHEM
KY
01
—
000001186679
CHA
KY
05
—
77001535
—
KY
Enumeration date
01/24/2007
Last updated
11/04/2019
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