Organization
JACKSON EYE CARE, INC
Active
Other names
RUSSELL B JACKSON OD
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL B JACKSON OD (OWNER OPERATOR)
(435) 743-6572
Entity
Organization
Contact information
Practice address
210 S 100 W, FILLMORE, UT 84631
(435) 743-6572
(435) 743-5558
Mailing address
PO BOX 73, FILLMORE, UT 84631-0073
(435) 743-6572
(435) 743-5558
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
375344-9934
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528882505001
—
UT
Enumeration date
12/27/2007
Last updated
12/27/2007
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