Individual
FREDRICK J JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
8436 VAUGHN RD, MONTGOMERY, AL 36117-8862
(334) 271-3900
(334) 271-3915
Mailing address
8436 VAUGHN RD, MONTGOMERY, AL 36117-8862
(334) 271-3900
(334) 271-3915
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S553TA209
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008605730
—
AL
01
—
BC51059948
AL51059948
AL
Enumeration date
07/05/2006
Last updated
07/09/2013
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