Individual
TRICHELLE MAE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
139 E K ST, FOREST CITY, IA 50436-1501
(641) 585-3590
(641) 585-4058
Mailing address
PO BOX 410, FOREST CITY, IA 50436-0410
(641) 585-3590
(641) 585-4058
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
002543
IA
Other
Enumeration date
05/12/2012
Last updated
02/22/2013
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