BRADLEY JACOBSEN (NPI# 1760845184) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760845184 |
| Entity Type | Individual |
| Full Name | BRADLEY JACOBSEN |
| Credential | M.D. |
| Practice Address |
515 E 100 S Ste 200 Salt Lake City UT 84102-2095 |
| Practice Telephone | 8015812401 |
| Mailing Telephone | (801) 581-2401 |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207W00000X | Ophthalmology | 10511526-1205 | UT | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | 10511526-1205 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1 Baylor Plz Ste 404d, Houston, TX 770303411 | 7137988629 |
| Street Address |
515 E 100 S STE 200 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84102-2095 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942642541 | Elizabeth Quigley | Pediatrics | 515 E 100 S Ste 200, Salt Lake City, UT 84102-2095 | 2013-07-23 |
| 1144827635 | Jawad Almajed | Student in an Organized Health Care Education/Training Program | 515 E 100 S Ste 200, Salt Lake City, UT 84102-2095 | 2020-10-07 |
| 1699392738 | Davide Marco Croci | Student in an Organized Health Care Education/Training Program | 515 E 100 S Ste 200, Salt Lake City, UT 84102-2095 | 2020-07-05 |
| 1083243794 | Ashley Brienza | Student in an Organized Health Care Education/Training Program | 515 E 100 S Ste 200, Salt Lake City, UT 84102-2095 | 2020-04-04 |
| 1881223931 | Vanina Lorena Taliercio | Student in an Organized Health Care Education/Training Program | 515 E 100 S Ste 200, Salt Lake City, UT 84102-2095 | 2020-04-02 |
| 1841828910 | Allison Mcclain | Student in an Organized Health Care Education/Training Program | 515 E 100 S Ste 200, Salt Lake City, UT 84102-2095 | 2020-04-01 |
| 1518595958 | Tyler Etheridge | Student in an Organized Health Care Education/Training Program | 515 E 100 S Ste 200, Salt Lake City, UT 84102-2095 | 2020-03-31 |
| 1023646635 | Charles Cubberley | Student in an Organized Health Care Education/Training Program | 515 E 100 S Ste 200, Salt Lake City, UT 84102-2095 | 2020-03-30 |
| 1922636620 | Troy Patrick Hatfield | Student in an Organized Health Care Education/Training Program | 515 E 100 S Ste 200, Salt Lake City, UT 84102-2095 | 2020-03-29 |
| 1003444035 | David Haak | Student in an Organized Health Care Education/Training Program | 515 E 100 S Ste 200, Salt Lake City, UT 84102-2095 | 2020-03-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942818604 | Wendy Vazquez | Behavior Technician | 515 S 700 E Suit 2a, Salt Lake City, UT 84102 | 2020-07-20 |
| 1407481245 | Odyssey House Inc | Family Medicine | 743 E 300 S, Salt Lake City, UT 84102 | 2020-03-11 |
| 1093359960 | Hayle Mayer | Behavior Technician | 515 S 700 E Salt Lake City, Suite 2a, Salt Lake, UT 84102 | 2019-11-04 |
| 1326680869 | Ronald Mcdonald House of The Intermountain Area | Meals | 935 E. South Temple, Salt Lake City, UT 84102 | 2019-10-16 |
| 1508419581 | Claire Pemberton | Behavior Technician | 327 E 1300 S, Apt 2, Salt Lake City, UT 84102 | 2019-07-19 |
| 1558923144 | Olivia Anne Hardwick | Social Worker | Transitions At Slrmc, 86 S. 1100 E. Suite 404, Salt Lake City, UT 84102 | 2019-07-03 |
| 1649741802 | Colten Vancampen | Behavior Technician | 515 S 700 E #2a, Salt Lake City, UT 84102 | 2018-12-16 |
| 1457847964 | Utah Podiatry Group PC | Podiatrist | 24 S 1100 E Ste 120, Salt Lake City, UT 84102 | 2018-07-09 |
| 1104311661 | Malorey Kooyman | Behavior Technician | 515 700 East, Suite 2a, Salt Lake City, UT 84102 | 2018-06-27 |
| 1700384930 | Utah Podiatry Group PC | Podiatrist | 82 S 1100 E Ste 301, Salt Lake City, UT 84102 | 2018-01-23 |
| Find all providers in zip 84102 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609421403 | Monika Fleckenstein | Ophthalmology | 65 Mario Capecchi Drive, John A. Moran Eye Center, Salt Lake City, UT 84132 | 2019-08-08 |
| 1568815082 | Anastasia Neufeld | Ophthalmology | 65 Mario Capecchi Drive, Salt Lake City, UT 84132 | 2016-07-20 |
| 1699126680 | Judd Michael Cahoon | Ophthalmology | 3281 E Santa Rosa Ave, Salt Lake City, UT 84109-4128 | 2016-06-30 |
| 1356706469 | John Christian Nelson | Ophthalmology | 3449 South 4155 West, Salt Lake City, UT 84109-2468 | 2015-12-17 |
| 1558660308 | Brian E Zaugg | Ophthalmology | John A Moran Eye Center 65 Mario Capecchi Dr, Salt Lake City, UT 84132-0001 | 2011-03-18 |
| 1770880346 | Gary Ricks Jones | Ophthalmology | 1924 S View St, Salt Lake City, UT 84105-3712 | 2011-02-17 |
| 1861792665 | Susan Crawford Chortkoff | Ophthalmology | John A Moran Eye Ctr, 65 North Mario Capecchi Drive, Salt Lake City, UT 84132-0001 | 2010-10-26 |
| 1689991747 | Kian Eftekhari | Ophthalmology | Eyelid Center of Utah, 22 S 900 E, Salt Lake City, UT 84102 | 2010-04-29 |
| 1760621940 | Bryan Paul Hemard Sr. | Ophthalmology | 6308 Canyon Cove Dr, Salt Lake City, UT 84121-6336 | 2009-02-12 |
| 1689833436 | Surgical Care Associates | Ophthalmology | 1025 East 3300 South, Suite B, Salt Lake City, UT 84106-4389 | 2008-06-06 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84102 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.