Individual
DR. JULIA REBECCA MEYER JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
723 S. FALLS BLVD, STE A, WYNNE, AR 72396-0562
(870) 238-2020
Mailing address
723 S. FALLS BLVD, STE A, WYNNE, AR 72396-0562
(870) 238-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2609
AR
152WC0802X
Corneal and Contact Management Optometrist
2609
AR
152WL0500X
Low Vision Rehabilitation Optometrist
2609
AR
152WP0200X
Pediatric Optometrist
2609
AR
152WV0400X
Vision Therapy Optometrist
2609
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175315722
—
AR
01
—
4T021
MEDICARE
AR
01
—
6477243001
PTAN
AR
Enumeration date
07/24/2008
Last updated
10/20/2022
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