Individual
KAYLYN R JACKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1710 S 70TH ST, LINCOLN, NE 68506-1676
(402) 484-9000
(402) 483-4223
Mailing address
1710 S 70TH ST, PO BOX 6068, LINCOLN, NE 68506-1676
(402) 484-9000
(402) 483-4223
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
991
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06909
BLUE SHIELD
NE
05
—
10025619800
—
NE
01
—
410039754
RAILROAD MEDICARE
NE
Enumeration date
07/07/2005
Last updated
09/01/2020
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