Individual
DR. JACOB AUSTIN TRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1595 DENMARK RD, UNION, MO 63084-4911
(636) 584-8989
(636) 584-0404
Mailing address
PO BOX 207158, DALLAS, TX 75320-7158
(636) 200-4393
(636) 527-0766
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2023022831
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/06/2023
Last updated
08/11/2023
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