Individual
MRS. JADE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.D.O
Contact information
Practice address
1240 PALM COAST PKWY SW, PALM COAST, FL 32137-4700
(386) 446-4210
(386) 445-7309
Mailing address
1240 PALM COAST PKWY SW, PALM COAST, FL 32137-4700
(386) 446-4210
(386) 445-7309
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
DO1284
FL
156FX1800X
Optician
Primary
DO3668
FL
156FX1800X
Optician
DO5189
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
630073100
—
FL
01
—
OP0463
EYE-MED
FL
Enumeration date
01/03/2007
Last updated
10/19/2020
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