Tiffany L Jackson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1900 Issued in NC

Practice address

273 N Front St
Wilmington, NC 28401-3907

Phone

(910) 341-4556

Fax

(866) 363-8330

NPI assigned

Apr 11, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2002

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dr.tiffany.jackson@direct.revolutionehr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• East Carolina Optometric Care, PA

  • Optometrist
  • Whiteville, NC
  • NPI 1558543884

  NC, Optometrist

  Medicare reassignment NPD Authorized official
• Coastal Vision Center

  • Optometrist
  • Wilmington, NC
  • NPI 1851443840
  NPD (past)
• Coastal Vision Center OD PA

  • Optometrist
  • Whiteville, NC
  • NPI 1194877373
  NPD (past)
• FS Tenant Pool I Trust

  • Skilled Nursing Facility
  • Myrtle Beach, SC
  • NPI 1841245313
  NPD (past)
• SNH SC Tenant LLC

  • Skilled Nursing Facility
  • Myrtle Beach, SC
  • NPI 1598312886
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669075200000",
    "number": "1083837546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2322 JAMES B WHITE HWY N",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284728970",
            "telephone_number": "910-914-6442",
            "fax_number": "910-914-6425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "273 N FRONT ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284013907",
            "telephone_number": "910-341-4556",
            "fax_number": "866-363-8330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TIFFANY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-11",
        "last_updated": "2022-11-22",
        "certification_date": "2022-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89093N2",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Latoya Jackson, MS,QP
• Mary Louise Jackson, NP
• Naomi Namrota Jackson, PA-C
• P Brian Jackson, OD
• Rebecca Grace Jackson, MSW, LCSW
• Woody H Jackson, MD
• Jacob R. Long, DDS, PLLC
• Jacob'S Business Ventures
• Cheyanne Nevaeh Jacobs
• Lila G Jacobs

• All providers in Wilmington, NC
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.