Provider Demographics
NPI:1992488613
Name:JACOBSEN EYE CARE LLC
Entity type:Organization
Organization Name:JACOBSEN EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:INEZ
Authorized Official - Last Name:JACOBSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:309-796-1444
Mailing Address - Street 1:704 CROSSTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:SILVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61282-1651
Mailing Address - Country:US
Mailing Address - Phone:309-796-1444
Mailing Address - Fax:309-796-1444
Practice Address - Street 1:704 CROSSTOWN AVE
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-1651
Practice Address - Country:US
Practice Address - Phone:309-796-1444
Practice Address - Fax:309-796-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty