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Contact Information

JACKSON EYE CARE, INC
51 E 400 N
SUITE 4A
CEDAR CITY, UT84720-2686
 Phone: 435-586-1500
 Fax: 435-865-0784
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for JACKSON EYE CARE, INC

NPI Number 1114100740
LBN Legal business name JACKSON EYE CARE, INC
Authorized official RUSSELL JACKSON - (OWNER OPERATOR)
Entity Organization
Organization subpart 1 No
Enumeration date 12/05/2007
Last updated 02/11/2008 - About 18 years ago
Identifiers
UT License # 375344-9934
UT Medicaid 528882505001
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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