Individual
DR. JACOBY JOHN DEWALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1418 MAIN ST, WOODWARD, OK 73801-3004
(580) 256-6699
(580) 256-6706
Mailing address
PO BOX 2484, WOODWARD, OK 73802-2484
(580) 256-6699
(580) 256-6706
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2647
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200298970A
—
OK
Enumeration date
06/22/2010
Last updated
09/21/2012
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