Provider Demographics
NPI:1124107685
Name:NACHUM, JACOB (OD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:NACHUM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BROADWAY
Mailing Address - Street 2:SUITE 908
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1703
Mailing Address - Country:US
Mailing Address - Phone:212-425-2115
Mailing Address - Fax:212-425-2636
Practice Address - Street 1:26 BROADWAY
Practice Address - Street 2:SUITE 908
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1703
Practice Address - Country:US
Practice Address - Phone:212-425-2115
Practice Address - Fax:212-425-2636
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00452600152W00000X
MAOPT3130152W00000X
CT2012152W00000X
NYTUV004314-01152WC0802X, 152WX0102X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC59271Medicare ID - Type Unspecified
NYT32221Medicare UPIN