Active NPI
Deanna Lynn Jackson, O.D
- Optometrist
- Parkersburg, WV
National Provider Identifier
1174801930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- WV1090
- Practice address
- 2014 Dudley Ave
Parkersburg, WV 26101-3405 - Phone
- (304) 422-1841
- Fax
- (304) 865-0592
- NPI assigned
- Jul 28, 2011
- Last updated
- Apr 8, 2022
- Sex
- Female
- 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 | WV1090 | WV | Primary |
Addresses
Primary practice location
2014 Dudley Ave
Parkersburg, WV 26101-3405
Mailing address
1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Southern California College of Optometry, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2014 Dudley Ave
Parkersburg, WV 26101-3405
Phone (304) 422-1841
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| WV1090 | WV | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Myeyedr Optometry of West Virginia, PLLC | Optometrist | Current | Accepting new patients |
| Myeyedr Optometry of West Virginia, PLLC | Optometrist | Current | Accepting new patients |
| Myeyedr Optometry of West Virginia, PLLC | Optometrist | Current | Accepting new patients |
| Myeyedr Optometry of West Virginia, PLLC | Optometrist | Past | Accepting new patients |
Locations
1950 Old Gallows Rd
Ste 520
Vienna, VA 22182
8614 Westwood Center Dr
Fl 9
Vienna, VA 22182
838 Somerset Blvd
Charles Town, WV 25414
Phone (304) 725-4828
2014 Dudley Ave
Parkersburg, WV 26101
Phone (304) 420-5783
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649376000000",
"number": "1174801930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1950 OLD GALLOWS RD STE 520",
"city": "VIENNA",
"state": "VA",
"postal_code": "221823970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2014 DUDLEY AVE",
"city": "PARKERSBURG",
"state": "WV",
"postal_code": "261013405",
"telephone_number": "304-422-1841",
"fax_number": "304-865-0592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DEANNA",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "O.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-28",
"last_updated": "2022-04-08",
"certification_date": "2022-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WV",
"license": "WV1090",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Parkersburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 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.