Individual
DR. JEFFREY ALAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1578
AZ
152W00000X
Optometrist
Primary
OPT-001578
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161292
—
AZ
Enumeration date
07/10/2007
Last updated
11/17/2021
Update your record
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