Individual
DR. AUTUMN H JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
73 VALLEY RD, MIDDLETOWN, RI 02842-5234
(401) 847-1040
(401) 847-1049
Mailing address
73 VALLEY RD, MIDDLETOWN, RI 02842-5234
(401) 847-1040
(401) 847-1049
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
4642
MA
152W00000X
Optometrist
Primary
ODTA00538
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0718769
—
MA
05
—
AJ73813
—
RI
Enumeration date
01/11/2008
Last updated
09/21/2022
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