Individual
GARY CHASE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
6030 W UNIVERSITY BLVD, ODESSA, TX 79764
(432) 640-6600
Mailing address
PO BOX 2129, ODESSA, TX 79760-2129
(432) 640-2408
(432) 640-4606
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
8568
TX
152W00000X
Optometrist
ODP-100307
ID
Other
Enumeration date
06/18/2014
Last updated
09/04/2014
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