Individual
GREGORY ROBBE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2880 DAUPHIN ST, MOBILE, AL 36606-2457
(251) 473-1900
(251) 470-8942
Mailing address
2880 DAUPHIN ST, MOBILE, AL 36606-2457
(251) 473-1900
(251) 470-8942
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S662TA239
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2210141
UNITED HEALTHCARE PROV #
AL
01
—
51079090
BLUE CROSS PROVIDER #
AL
01
—
5835512
AETNA PIN
AL
01
—
U18672
HEALTHSPRING PROVIDER #
AL
Enumeration date
06/16/2005
Last updated
11/19/2007
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