Individual
DR. LEE R JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1357 2ND AVE, CUMBERLAND, WI 54829-7211
(715) 822-2091
(715) 822-3624
Mailing address
1357 2ND AVE, CUMBERLAND, WI 54829-7211
(715) 822-2091
(715) 822-3624
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1298
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38541900
—
WI
01
—
410011362
RR-PTAN 410011362
WI
01
—
410040506
RR-PTAN 410040506
WI
Enumeration date
07/21/2005
Last updated
12/14/2009
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