Organization
DR. M.E. JACKSON OPTOMETRIST PC
Active
Other names
Dr. M.E. Jackson O.D., P.C.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MELVIN EUGENE JACKSON O.D. (DOCTOR/ SOLE OWNER)
(757) 464-5842
Entity
Organization
Contact information
Practice address
4642 HAYGOOD RD, SUITE 1, VIRGINIA BEACH, VA 23455-5436
(757) 464-5842
(757) 464-4745
Mailing address
4642 HAYGOOD RD, SUITE 1, VIRGINIA BEACH, VA 23455-5436
(757) 464-5842
(757) 464-4745
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000174
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0092-0598-5
—
VA
01
—
040971
BLUE CROSS & BLUE SHIELD
VA
01
—
1588657217
NPI
—
Enumeration date
04/13/2010
Last updated
04/13/2010
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