Individual
DR. CHERYL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
233 WASHINGTON ST, WOODSTOCK, IL 60098-3399
(815) 338-0674
(815) 338-6139
Mailing address
233 WASHINGTON ST, WOODSTOCK, IL 60098-3399
(815) 338-0674
(815) 338-6139
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008108
IL
152WC0802X
Corneal and Contact Management Optometrist
046008108
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046008108
—
IL
Enumeration date
10/20/2006
Last updated
04/08/2015
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