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NPI Lookup from the NPI Registry — National Provider Identifier Database

Contact Information

JEFFREY A JACKSON, OD
560 N CAMINO MERCADO STE 1
CASA GRANDE, AZ85122-5759
 Phone: 520-426-9224
 Fax: 520-426-1554
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for JEFFREY A JACKSON · (Male)

NPI Number 1003014051
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 07/10/2007
Last updated 11/09/2018 - About 10 months ago
Sole proprietor 1 Yes
Identifiers
  • AZ License # 1578
  • AZ Medicaid Z190423
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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