Individual
GARY LEONARD JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
13132 CORTEZ BLVD, BROOKSVILLE, FL 34613-4858
(352) 597-0410
(352) 597-0420
Mailing address
6316 BAYSIDE DR, NEW PORT RICHEY, FL 34652-2038
(727) 845-8112
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DO3669
FL
Other
Enumeration date
05/18/2007
Last updated
07/08/2007
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