Organization
JACKSONEYE SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MITCHELL ALIN JACKSON MD (CEO OWNER)
(847) 356-0700
Entity
Organization
Contact information
Practice address
300 N MILWAUKEE AVE, SUITE L, LAKE VILLA, IL 60046
(847) 356-0700
(847) 356-0757
Mailing address
300 N MILWAUKEE AVE, SUITE L, LAKE VILLA, IL 60046
(847) 356-0700
(847) 356-0700
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004932263
BCBS
IL
Enumeration date
01/26/2007
Last updated
08/22/2020
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