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Contact Information

RUSSELL B JACKSON, OD
210 S 100 E
FILLMORE, UT84631-2500
 Phone: 435-743-6572
 Fax: 435-743-5558
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for RUSSELL B JACKSON · (Male)

NPI Number 1922008663
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 07/22/2005
Last updated 12/05/2007 - About 19 years ago
Sole proprietor 1 No
Identifiers
  • UT License # 375344-9934
  • UT Other 37534499300001 BLUE CROSS
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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