Active NPI
George Jackson
- Ophthalmology Physician
- Stuart, FL
National Provider Identifier
1659755486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 80921
- Practice address
- 5000 SE Burning Tree Cir
Stuart, FL 34997-8701 - Phone
- (772) 631-5813
- Fax
- (772) 286-9514
- NPI assigned
- Jul 10, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 80921 | NY | Primary |
Addresses
Primary practice location
5000 SE Burning Tree Cir
Stuart, FL 34997-8701
Mailing address
5000 SE Burning Tree Cir
Stuart, FL 34997-8701
Phone (772) 631-5813
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80921 | NY | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1436486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436486400000",
"number": "1659755486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5000 SE BURNING TREE CIR",
"city": "STUART",
"state": "FL",
"postal_code": "349978701",
"telephone_number": "772-631-5813",
"fax_number": "772-286-9514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5000 SE BURNING TREE CIR",
"city": "STUART",
"state": "FL",
"postal_code": "349978701",
"telephone_number": "772-631-5813",
"fax_number": "772-286-9514"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "GEORGE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-07-10",
"last_updated": "2015-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NY",
"license": "80921",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stuart, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.