Individual
DANIEL MARK JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
713 N 114TH ST, OMAHA, NE 68154-1515
(402) 991-3131
Mailing address
713 N 114TH ST, OMAHA, NE 68154-1515
(402) 991-3131
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
960
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025388400
—
NE
05
—
10025388500
—
NE
05
—
10025583800
—
NE
01
—
37154
BCBS
NE
01
—
904415
SHARE ADVANTAGE
NE
01
—
P00393695
RR MEDICARE
NE
Enumeration date
07/18/2005
Last updated
06/01/2016
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