Provider Demographics
NPI:1457919029
Name:JACKOWSKI, JAMIE JACOBS (OD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:JACOBS
Last Name:JACKOWSKI
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 1:4244 INDIAN RIPPLE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3279
Mailing Address - Country:US
Mailing Address - Phone:937-320-0300
Mailing Address - Fax:
Practice Address - Street 1:4244 INDIAN RIPPLE RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3279
Practice Address - Country:US
Practice Address - Phone:937-320-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006750152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist