Provider Demographics
NPI:1528104999
Name:REZNIK, JACOB (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:REZNIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 AVOCADO AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7787
Mailing Address - Country:US
Mailing Address - Phone:949-288-2382
Mailing Address - Fax:949-288-0344
Practice Address - Street 1:1401 AVOCADO AVE STE 302
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7787
Practice Address - Country:US
Practice Address - Phone:949-288-2382
Practice Address - Fax:949-288-0344
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA101891207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology