Active NPI
Kevin Michael Jackson, O.D.
- Optometrist
- Bethesda, MD
National Provider Identifier
1588654115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- T006010
- Practice address
- 4494 Palmer Rd N
Bethesda, MD 20814 - Phone
- (301) 295-3016
- NPI assigned
- Oct 25, 2005
- Sex
- Male
- 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 | T006010 | NY | Primary |
Addresses
Primary practice location
4494 Palmer Rd N
Bethesda, MD 20814
Mailing address
4301 Jones Bridge Rd
Bethesda, MD 20814-4712
Phone (301) 295-3016
Other practice location 1
695 Kinkaid Rd
Annapolis, MD 21402-1006
Phone (410) 293-1790
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180927002841 | NY | Order and Referring Only - Optometry | 3678824786 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T006010 | NY | MD | Optometrist |
| 006010 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1762387200000",
"number": "1588654115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4301 JONES BRIDGE RD",
"city": "BETHESDA",
"state": "MD",
"postal_code": "208144712",
"telephone_number": "301-295-3016"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4494 PALMER RD N",
"city": "BETHESDA",
"state": "MD",
"postal_code": "20814",
"telephone_number": "301-295-3016"
}
],
"practiceLocations": [
{
"address_1": "695 Kinkaid Rd",
"address_purpose": "LOCATION",
"city": "Annapolis",
"state": "MD",
"postal_code": "214021006",
"country_code": "US",
"telephone_number": "410-293-1790",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "KEVIN",
"middle_name": "MICHAEL",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-25",
"last_updated": "2025-11-06",
"certification_date": "2025-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "T006010",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bethesda, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.