Individual
JONATHAN FLOYD JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5135 CAROLINA BEACH RD, WILMINGTON, NC 28412-2516
(910) 793-1157
(910) 793-1158
Mailing address
5443 MARINA CLUB DR, WILMINGTON, NC 28409-4104
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1907
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89093NY
—
NC
Enumeration date
01/12/2007
Last updated
07/08/2007
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