Individual
DR. KEVIN JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1905 ABBOT RD STE 1, EAST LANSING, MI 48823-8571
(517) 580-8733
(517) 337-1854
Mailing address
1905 ABBOT RD STE 1, EAST LANSING, MI 48823-8571
(517) 580-8733
(517) 337-1854
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004013
MI
152WC0802X
Corneal and Contact Management Optometrist
4901004013
MI
152WP0200X
Pediatric Optometrist
4901004013
MI
152WV0400X
Vision Therapy Optometrist
4901004013
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1019456
MCLAREN
MI
01
—
22-00122
PHYSICANS HEALTH PLAN-PHP
MI
01
—
22-70122
PHP-MEDICAID
MI
05
—
86-4792288
—
MI
01
—
900C313100
BCBS
MI
05
—
94-4318770
—
MI
Enumeration date
05/19/2006
Last updated
01/12/2021
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