Taylor Kiyota Jackson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT0003599 Issued in CO

Practice address

5900 Keyes St Ste 101
Frederick, CO 80504-5956

Phone

(303) 833-1056

NPI assigned

Jun 13, 2020

Last updated

May 15, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern California College of Optometry, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carbon Valley Eye CareGroup PAC ID 1557585528, 5 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Carbon Valley Eye Care

  • Optometrist
  • Frederick, CO
  • NPI 1235558065
  Medicare reassignment Care Compare group NPD
• Lisa M Hamilton, PC

  dba Active Eyes, PC

  • Optometrist
  • Littleton, CO
  • NPI 1033320361
  Medicare reassignment

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

{
    "created_epoch": "1592006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621036800000",
    "number": "1275158404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6408 DRY FORK DR",
            "city": "FREDERICK",
            "state": "CO",
            "postal_code": "805169510",
            "telephone_number": "303-921-2307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 KEYES ST STE 101",
            "city": "FREDERICK",
            "state": "CO",
            "postal_code": "805045956",
            "telephone_number": "303-833-1056"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 Iron Horse Dr Apt B102",
            "address_purpose": "LOCATION",
            "city": "Longmont",
            "state": "CO",
            "postal_code": "805015704",
            "country_code": "US",
            "telephone_number": "303-921-2307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TAYLOR",
        "middle_name": "KIYOTA",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-13",
        "last_updated": "2021-05-15",
        "certification_date": "2021-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "OPT0003599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maggie Hood-Nugent
• Heidi Marie Hoyt, RN, L.AC
• Andrew P Hughes, PT,DPT,CSCS
• Huntleigh Healthcare LLC
• Integral Physical Therapy LLC (Integral Physical Therapy)
• Aveein Cheaih Jaff
• Samantha M Jandro
• Janis Sue Jenkins, DDS
• Jade Jette, PT, DPT
• Jessalyn Jobes

• Optometrist in Frederick, CO
• Providers in Frederick, CO by specialty
• Optometrist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2021; 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.

Verify at the official NPI Registry.