Individual
P BRIAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
6825 PARKER FARM DR, WILMINGTON, NC 28405-3168
(910) 452-0554
(910) 452-0767
Mailing address
7100 SIX FORKS RD, SUITE 301, RALEIGH, NC 27615-6156
(919) 847-0187
(919) 676-2231
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1294
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
093VY
BLUE CROSS BLUE SHIELD
NC
05
—
809042B
—
NC
01
—
P00789509
MEDICARE RAILROAD CARRIER
NC
Enumeration date
06/09/2006
Last updated
03/29/2023
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