Michaelis Jackson & Associates, LLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

MICHAELIS JACKSON & ASSOCIATES, LLC

Doing business as

Jackson Vision & Laser Centers

Practice address

500 Lincoln Dr
Suite a
Herrin, IL 62948-6334

Phone

(618) 351-8900

Fax

(618) 351-0076

NPI assigned

Jan 3, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Michaelis Jackson, MD

Title

President

Phone

(618) 351-8900

Specialties & licenses 2

Addresses

Other names 1

• Jackson Vision & Laser Centers Doing business as

Locations

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189123200000",
    "number": "1144387333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 W MAIN ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011087",
            "telephone_number": "618-351-8900",
            "fax_number": "618-351-0076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 LINCOLN DR",
            "address_2": "SUITE A",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629486334",
            "telephone_number": "618-351-8900",
            "fax_number": "618-351-0076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAELIS JACKSON & ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2007-09-07",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MICHAELIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-351-8900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Vision & Laser Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gillian McVicar, PA-C
• Wrophas Meeks, MD
• Karan Mehta, MD
• Lisa Renee Melton, LCSW
• Cortney Dawn Meyer
• Rachel Michels
• Midwest Ear Nose & Throat Clinic, S.C.
• Joshua James Miksanek, M.D.
• Roseanne P Miksanek, PHARMD, BCPS
• Amy Leeann Miller, APRN

• Ophthalmology Physician in Herrin, IL
• Providers in Herrin, IL by specialty
• Ophthalmology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.