Provider Demographics
NPI:1316102692
Name:JACOB, ERIN MICHELLE (OD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MICHELLE
Last Name:JACOB
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W SAN ANTONIO ST
Mailing Address - Street 2:
Mailing Address - City:LOCKHART
Mailing Address - State:TX
Mailing Address - Zip Code:78644-2421
Mailing Address - Country:US
Mailing Address - Phone:512-398-7600
Mailing Address - Fax:512-398-3333
Practice Address - Street 1:1001 W SAN ANTONIO ST
Practice Address - Street 2:
Practice Address - City:LOCKHART
Practice Address - State:TX
Practice Address - Zip Code:78644-2421
Practice Address - Country:US
Practice Address - Phone:512-398-7600
Practice Address - Fax:512-398-3333
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7279T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist