Organization
M D JACKMAN OD & ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MERL D JACKMAN OD (OWNER)
(512) 323-6996
Entity
Organization
Contact information
Practice address
1000 W 39TH ST, AUSTIN, TX 78756-4008
(512) 323-6996
(512) 452-0015
Mailing address
1000 W 39TH ST, AUSTIN, TX 78756-4008
(512) 323-6996
(512) 452-0015
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2404TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0083WW
BCBS OF TEXAS
TX
01
—
2404TG
TEXAS OPTOMETRY LICENSE
TX
Enumeration date
01/19/2012
Last updated
06/14/2012
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