Active NPI
Michael Wayne Jackson, O.D.
- Optometrist
- Oakland, CA
National Provider Identifier
1174593388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 6056T
- Practice address
- 1741 Broadway
Oakland, CA 94612-2105 - Phone
- (510) 835-8344
- Fax
- (510) 835-8346
- NPI assigned
- Jan 23, 2006
- 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 | 6056T | CA | Primary |
Addresses
Primary practice location
1741 Broadway
Oakland, CA 94612-2105
Mailing address
1741 Broadway
Oakland, CA 94612-2105
Phone (510) 835-8344
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0060560 | Medicaid | CA |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6056T | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bay Vision Eyecare Optometry, Inc. | Optometrist | 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.
-
- Optometrist
- Oakland, CA
- NPI 1376784413
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1174593388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1741 BROADWAY",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946122105",
"telephone_number": "510-835-8344",
"fax_number": "510-835-8346"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1741 BROADWAY",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946122105",
"telephone_number": "510-835-8344",
"fax_number": "510-835-8346"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MICHAEL",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-23",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "6056T",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0060560",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.