Individual
JOHN MARK JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1225 MADISON AVE, MEMPHIS, TN 38104
(901) 722-3250
(901) 722-3347
Mailing address
1245 MADISON AVE, MEMPHIS, TN 38104-2211
(901) 722-3250
(901) 722-3347
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2288
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2288
OD
TN
05
—
3944619
—
TN
Enumeration date
08/24/2005
Last updated
03/07/2023
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