Individual
PHILLIP BRIAN JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
136 CHURCH STREET, CHESTER, SC 29706
(803) 581-7400
(803) 581-0124
Mailing address
136 CHURCH STREET, PO BOX 791, CHESTER, SC 29706
(803) 581-7400
(803) 581-0124
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
720
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DD0720
—
SC
Enumeration date
04/20/2006
Last updated
09/13/2013
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