Active NPI
Jay A Jackson, O.D.
- Optometrist
- Savannah, GA
National Provider Identifier
1104975838
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT001191
- Practice address
- 5500 Abercorn St
12 Oaks Plaza Suite 24
Savannah, GA 31405-6913 - Phone
- (912) 352-3478
- NPI assigned
- Jan 10, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT001191 | GA | Primary |
Addresses
Primary practice location
5500 Abercorn St
12 Oaks Plaza Suite 24
Savannah, GA 31405-6913
Mailing address
23 Monastery Rd
Savannah, GA 31411-1737
Phone (912) 398-0418
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1191 | GA | MD | Clinical Psychologist |
| OPT001191 | GA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Publix Super Markets Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
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- NPI 1760356380
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386806400000",
"number": "1104975838",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23 MONASTERY RD",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314111737",
"telephone_number": "912-398-0418"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5500 ABERCORN ST",
"address_2": "12 OAKS PLAZA SUITE 24",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314056913",
"telephone_number": "912-352-3478"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JAY",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-10",
"last_updated": "2013-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "GA",
"license": "OPT001191",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Savannah, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.