Provider Demographics
NPI:1447923404
Name:BELLAMY, JACOB M (OD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:M
Last Name:BELLAMY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 BOARDWALK
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6372
Mailing Address - Country:US
Mailing Address - Phone:405-321-2155
Mailing Address - Fax:405-321-1170
Practice Address - Street 1:2501 BOARDWALK
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6372
Practice Address - Country:US
Practice Address - Phone:405-321-2155
Practice Address - Fax:405-321-1170
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3111152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist