Organization
SUBURBAN OPTOMETRICS ASSOC P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN P JACOBI O.D., F.C.O.V.D. (OPTOMETRIST)
(734) 525-8170
Entity
Organization
Contact information
Practice address
32415 5 MILE RD, LIVONIA, MI 48154-3039
(734) 525-8170
(734) 525-0726
Mailing address
32415 5 MILE RD, LIVONIA, MI 48154-3039
(734) 525-8170
(734) 525-0726
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
4901003184
MI
152W00000X
Optometrist
Primary
4901003208
MI
152W00000X
Optometrist
4901004024
MI
152W00000X
Optometrist
4901004851
MI
152WL0500X
Low Vision Rehabilitation Optometrist
4901003184
MI
152WV0400X
Vision Therapy Optometrist
4901003208
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2603194
—
MI
05
—
4309851
—
MI
Enumeration date
05/17/2007
Last updated
03/22/2016
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