Individual
DR. JACOB A IVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
14994 W MAIN ST, LOUISVILLE, MS 39339-2616
(662) 773-3494
(662) 773-7883
Mailing address
14994 W MAIN ST, LOUISVILLE, MS 39339-2616
(662) 773-3494
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
762
MS
152W00000X
Optometrist
PENDING
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09351503
—
MS
Enumeration date
07/19/2006
Last updated
04/12/2022
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