Individual
DR. MARK EDWARD JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
NC 1366
NC
152W00000X
Optometrist
NY 005118
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0908J
BCBS
NC
05
—
890908J
—
NC
Enumeration date
06/09/2006
Last updated
12/11/2020
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