Individual
DIANE M JACOBI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1974 NORTH HURON RIVER DRIVE, YPSILANTI, MI 48197
(734) 615-0788
Mailing address
3621 S STATE ST, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003255
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4154589
—
MI
Enumeration date
01/22/2007
Last updated
08/09/2013
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