Dr. M.E. Jackson Optometrist PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618000174 Issued in VA

Legal business name

DR. M.E. JACKSON OPTOMETRIST PC

Practice address

4642 Haygood Rd
Suite 1
Virginia Beach, VA 23455-5436

Phone

(757) 464-5842

Fax

(757) 464-4745

NPI assigned

Apr 13, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Melvin Eugene Jackson, O.D.

Title

Doctor/ Sole Owner

Phone

(757) 464-5842

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Dr. M.E. Jackson O.D., P.C. Other name

Locations

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

{
    "created_epoch": "1271116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271116800000",
    "number": "1497071625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4642 HAYGOOD RD",
            "address_2": "SUITE 1",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234555436",
            "telephone_number": "757-464-5842",
            "fax_number": "757-464-4745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4642 HAYGOOD RD",
            "address_2": "SUITE 1",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234555436",
            "telephone_number": "757-464-5842",
            "fax_number": "757-464-4745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. M.E. JACKSON OPTOMETRIST PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-13",
        "last_updated": "2010-04-13",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MELVIN",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "DOCTOR/ SOLE OWNER",
        "authorized_official_telephone_number": "757-464-5842",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618000174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1588657217",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0092-0598-5",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "040971",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. M.E. Jackson O.D., P.C.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Optometrist in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2010; 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.