Individual
PAULA I JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
704 CROSSTOWN AVE, SILVIS, IL 61282-1651
(309) 796-1444
(309) 796-1496
Mailing address
704 CROSSTOWN AVE, SILVIS, IL 61282-1651
(309) 796-1444
(309) 796-1496
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-008226
IL
152W00000X
Optometrist
1896
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08184019
BLUE CROSS BLUE SHIELD OF IL
IL
Enumeration date
09/20/2005
Last updated
08/09/2023
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