Individual
DR. CHAD J JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
6575 BELDING RD NE, SUITE D, ROCKFORD, MI 49341-7418
(616) 874-2020
(616) 874-2773
Mailing address
6575 BELDING RD NE STE D, ROCKFORD, MI 49341-7417
(616) 874-2020
(616) 874-2773
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003954
MI
152WC0802X
Corneal and Contact Management Optometrist
4901003954
MI
152WP0200X
Pediatric Optometrist
4901003954
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
90OD114940
BLUECROSS/BLUE SHEILD
MI
Enumeration date
10/10/2006
Last updated
11/26/2018
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