Provider Demographics
NPI:1699516898
Name:LOCK, JACOB DANIEL (OD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:DANIEL
Last Name:LOCK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:460 E NINE MILE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-1441
Mailing Address - Country:US
Mailing Address - Phone:850-477-1499
Mailing Address - Fax:850-479-3359
Practice Address - Street 1:4377 WOODBINE RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8792
Practice Address - Country:US
Practice Address - Phone:850-995-4555
Practice Address - Fax:850-995-4556
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOPC6464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist