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Individual

DR. STEPHANIE JACOB

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
20 FERGUSON BLVD, DRY RIDGE, KY 41035-8635
(859) 824-1333
Mailing address
9100 BRANTLEY WAY, FLORENCE, KY 41042-8684
(859) 384-7646

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1452DT
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000001216878
CHA
KY
01
5013OD
HUMANA
KY
05
77001576
KY
01
DAVIS
47900
KY
Enumeration date
03/06/2007
Last updated
07/09/2007
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