NPI: 1780851972 · INDIANOLA, IA 50125 · General Practice Dentistry · NPI assigned 05/15/2008
| Authorized Official | JACOBSEN, GARY (PRESIDENT) |
| NPI Enumeration Date | 05/15/2008 |
Other providers sharing the same authorized official: JACOBSEN, GARY
| Provider | City | State | Total Paid |
|---|---|---|---|
| GLENDIVE EYECARE | GLENDIVE | MT | $19K |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 35 | $896.65 |
| 2019 | 30 | $913.33 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | 65 | 65 | $2K |