# JACKSONEYE SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073669834
- **Authorized official:** DR. MITCHELL ALIN JACKSON MD (CEO OWNER)
- **Authorized official phone:** (847) 356-0700

## Contact information

- **Practice address:** 300 N MILWAUKEE AVE, SUITE L, LAKE VILLA, IL 60046
- **Practice address phone:** (847) 356-0700
- **Practice address fax:** (847) 356-0757
- **Mailing address:** 300 N MILWAUKEE AVE, SUITE L, LAKE VILLA, IL 60046
- **Mailing address phone:** (847) 356-0700
- **Mailing address fax:** (847) 356-0700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/26/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0004932263 | BCBS | IL |