Individual
KEVIN E JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1801 W KNAPP ST, STE 3, RICE LAKE, WI 54868
(715) 234-3113
(715) 234-2339
Mailing address
1801 W KNAPP ST, STE 3, RICE LAKE, WI 54868
(715) 234-3113
(715) 234-2339
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2084
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38527700
—
WI
Enumeration date
07/28/2006
Last updated
07/08/2007
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