Individual
ALYSSA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
3929 LAMAR DR, CLARKSVILLE, TN 37040-3704
(931) 245-3979
(931) 647-0354
Mailing address
3929 LAMAR DR STE. B, CLARKSVILLE, TN 37040-1425
(931) 245-3937
(931) 647-0354
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3377
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3377
LICENSE NUMBER
TN
Enumeration date
06/19/2017
Last updated
02/13/2020
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