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DR. RODNEY LEIGH JACOB O.D.

>> Optometrist >> Eye and Vision Services Providers

Registrant NPI Number: 1730294893

Individual Registrant:
DR. RODNEY LEIGH JACOB O.D.
Gender: M
Not Sole Proprietor

Location and contact information for practice:
INDIAN ROUTE 64 AND 12 TSAILE HEALTH CLINIC TSAILE, AZ 85665-0021 US
Tel: 928-724-3707  Fax: 928-724-3781

Contact information for business:
PO BOX 451  TSAILE, AZ 86556-0451 US
Tel: 928-724-3162  Fax: 928-724-3781

Registration Information:
NPI: 1730294893
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N152W00000XEye and Vision Services Providers
Optometrist
MS816
Y152W00000XEye and Vision Services Providers
Optometrist
OK2548

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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