Organization
JACKSON OPTICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN MASON (OWNER)
(941) 625-6602
Entity
Organization
Contact information
Practice address
4265 TAMIAMI TRL, SUITE G, PORT CHARLOTTE, FL 33980-2152
(941) 625-6602
(941) 625-0021
Mailing address
4265 TAMIAMI TRL, SUITE G, PORT CHARLOTTE, FL 33980-2152
(941) 625-6602
(941) 625-0021
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
OE702
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5488960001
PALMETTO
FL
Enumeration date
08/16/2007
Last updated
10/22/2007
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