Individual
DR. ANGELA KATHRYN JACKSON
Active
Individual
DR. ANGELA KATHRYN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4846
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000185975
ANTHEM
ND
01
—
03158
PARAMOUNT
OH
05
—
2051416
—
OH
01
—
5850518
AETNA
OH
Enumeration date
08/24/2005
Last updated
05/20/2021
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