Individual
DR. JASON KENNETH DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2617 HIGHWAY 31 S, PELHAM, AL 35124-1322
(205) 664-1575
(205) 664-1578
Mailing address
2617 HIGHWAY 31 S, PELHAM, AL 35124-1322
(205) 664-1575
(205) 664-1578
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-982-TA-567
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009933935
—
AL
01
—
51505633
BLUE CROSS BLUE SHIELD
AL
01
—
U86291
HEALTHSPRING
AL
Enumeration date
08/19/2005
Last updated
06/10/2008
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