Kevin Ryan Jackson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1814DT Issued in KY

Practice address

484 Golden Autumn Way Ste 201
Bowling Green, KY 42103-6914

Phone

(270) 780-2494

Fax

(270) 780-0465

NPI assigned

Jul 19, 2010

Last updated

Nov 10, 2021By the provider in NPPES

Sex

Male

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 KY

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

Indiana University - School of Optometry, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Graves Gilbert Clinic PLLCGroup PAC ID 4082511167, 207 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kevinjackson@ggc.allscriptsdirect.net

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.

• Graves Gilbert Clinic PLLC

  dba Graves Gilbert Clinic

  • Specialist
  • Bowling Green, KY
  • NPI 1114948288

  Optometrist

  Medicare reassignment Care Compare group NPD
• Graves Gilbert Clinic PLLC

  dba GGC Rural Health Clinic Cave City

  • Rural Health Clinic/Center
  • Cave City, KY
  • NPI 1104635663
  NPD
• Ky Doctors of Optometry, PLLC

  dba KY Doctors of Optometry

  • Optometrist
  • Louisville, KY
  • NPI 1700890001
  NPD

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

{
    "created_epoch": "1279497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636502400000",
    "number": "1588977508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 PARK ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011708",
            "telephone_number": "270-781-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "484 GOLDEN AUTUMN WAY STE 201",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421036914",
            "telephone_number": "270-780-2494",
            "fax_number": "270-780-0465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KEVIN",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-19",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1814DT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Ann Jackson, APRN, PMHNP-BC
• Canon Peyton Jackson, BS
• Darlasue Katrice Jackson, SLP
• Dolores Jackson
• Eli O. Jackson, D.M.D.
• Lori Ann Jackson, ARNP
• Megan Kay Jackson, APRN
• Milton Schreiner Jackson, MD
• Miranda Hulett Jackson, PHARM D
• Sheena N Jackson

• Optometrist in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 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.