Jonathan Floyd Jackson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1907 Issued in NC

Practice address

5135 Carolina Beach Rd
Wilmington, NC 28412-2516

Phone

(910) 793-1157

Fax

(910) 793-1158

NPI assigned

Jan 12, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

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

Pennsylvania College of Optometry, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jackson Eye Associates, OD, PAGroup PAC ID 7618062753, 2 clinicians

Carolina Vision Associates OD PAGroup PAC ID 6901022573, 2 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.

• Carolina Vision Associates, OD, PA

  • Optometrist
  • Wilmington, NC
  • NPI 1487902334
  Medicare reassignment Care Compare group NPD Authorized official
• Jackson Eye Associates, OD, PA

  • Optometrist
  • Wilmington, NC
  • NPI 1619180387
  Medicare reassignment Care Compare group NPD
• Jackson Eye Associates

  • Optometrist
  • Raleigh, NC
  • NPI 1356649362
  NPD (past)
• Jackson Eye Associates, OD PA

  • Optometrist
  • Wilmington, NC
  • NPI 1215232269
  NPD (past)
• Jackson Eye Associates, OD PA

  • Optometrist
  • Leland, NC
  • NPI 1427384668
  NPD (past)
• Jackson Eye Associates, OD PA

  • Optometrist
  • Wilmington, NC
  • NPI 1548596778
  NPD (past)

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407906084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5443 MARINA CLUB DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284094104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JONATHAN",
        "middle_name": "FLOYD",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89093NY",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cory Daniel Jackson
• Eric Michael Jackson, M.D.
• Jennifer Ann Jackson, LCSWA
• Jerry Edwin Jackson Jr., LPC
• Joann Kate Jackson, PAC
• Joseph Alan Jackson, LCMHCA
• Latoya Jackson, MS,QP
• Mary Louise Jackson, NP
• Naomi Namrota Jackson, PA-C
• P Brian Jackson, OD

• Optometrist in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.