Individual
MR. CARL J JACOBSEN SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CERTIFIED OPTICIAN A
Contact information
Practice address
715 WEST AVE, JENKINTOWN, PA 19046-2710
(215) 884-7715
(215) 884-7715
Mailing address
715 WEST AVE, JENKINTOWN, PA 19046-2710
(215) 884-7715
(215) 884-7920
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0743370001
PROVIDER NUMBER
—
Enumeration date
12/04/2007
Last updated
12/04/2007
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