Individual
LISA JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
400 HILLSIDE AVE, NEEDHAM, MA 02494-1263
(781) 444-6610
Mailing address
204 TUDOR RD, NEEDHAM, MA 02492-4312
(781) 444-5435
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3837
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0392448
—
MA
Enumeration date
09/21/2006
Last updated
07/08/2007
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