# MICHAELIS JACKSON & ASSOCIATES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jackson Vision & Laser Centers
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144387333
- **Authorized official:** DR. MICHAELIS JACKSON MD (PRESIDENT)
- **Authorized official phone:** (618) 351-8900

## Contact information

- **Practice address:** 500 LINCOLN DR, SUITE A, HERRIN, IL 62948-6334
- **Practice address phone:** (618) 351-8900
- **Practice address fax:** (618) 351-0076
- **Mailing address:** 2800 W MAIN ST, CARBONDALE, IL 62901-1087
- **Mailing address phone:** (618) 351-8900
- **Mailing address fax:** (618) 351-0076

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | IL | — |
| 207W00000X | Ophthalmology Physician | — | IL | Yes |

## Other

- **Enumeration date:** 01/03/2007
- **Last updated:** 09/07/2007