NPIMap

Organization Active NPI

Jackson Eye Associates, OD PA

  • Optometrist
  • Wilmington, NC
National Provider Identifier
1215232269
Registry record updated Jan 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1907 Issued in NC
Legal business name
JACKSON EYE ASSOCIATES, OD PA
Practice address
1611 Greenfield St
Wilmington, NC 28401-6455
Phone
(910) 264-3625
Fax
(910) 392-5899
NPI assigned
Jan 24, 2011
Last updated
Jan 24, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2011

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

Authorized official

Name
Mrs. Cheri Beth Clabby
Title
Office Manager
Phone
(910) 793-1157

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1907 NC Primary

Addresses

Primary practice location

1611 Greenfield St
Wilmington, NC 28401-6455

Mailing address

5135 Carolina Beach Rd
Wilmington, NC 28412-2516
Phone (910) 793-1157

Other identifiers 1

IdentifierTypeStateIssuer
5908347MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Jackson Eye Associates OD PA5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1295827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295827200000",
    "number": "1215232269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5135 CAROLINA BEACH RD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284122516",
            "telephone_number": "910-793-1157",
            "fax_number": "910-793-1158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 GREENFIELD ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284016455",
            "telephone_number": "910-264-3625",
            "fax_number": "910-392-5899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON EYE ASSOCIATES, OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-24",
        "last_updated": "2011-01-24",
        "status": "A",
        "authorized_official_last_name": "CLABBY",
        "authorized_official_first_name": "CHERI",
        "authorized_official_middle_name": "BETH",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "910-793-1157",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5908347",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2011; 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.