Provider Demographics
NPI:1316118763
Name:ROBERT W JACEY MD PC
Entity type:Organization
Organization Name:ROBERT W JACEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAUGHTER
Authorized Official - Suffix:
Authorized Official - Credentials:COA
Authorized Official - Phone:804-517-5555
Mailing Address - Street 1:712 TRAIN LN
Mailing Address - Street 2:
Mailing Address - City:HEATHSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22473-4595
Mailing Address - Country:US
Mailing Address - Phone:804-517-5555
Mailing Address - Fax:804-737-9058
Practice Address - Street 1:712 TRAIN LN
Practice Address - Street 2:
Practice Address - City:HEATHSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22473-4595
Practice Address - Country:US
Practice Address - Phone:804-517-5555
Practice Address - Fax:804-724-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101024617207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006380069Medicaid
VAC03829OtherMEDICARE GROUP
VAB07981Medicare UPIN
VAC03829OtherMEDICARE GROUP