Individual
DR. JACOB ANTHONY MICHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
142 PAVILION PKWY, NEWPORT, KY 41071-2884
(859) 291-9464
(859) 291-3222
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2007DT
KY
152W00000X
Optometrist
6219
OH
Other
Enumeration date
06/19/2013
Last updated
03/21/2022
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