Jade Jackson, L.D.O

Primary specialty

OpticianTaxonomy code 156FX1800X

License

DO3668 Issued in FL

Practice address

1240 Palm Coast Pkwy SW
Palm Coast, FL 32137-4700

Phone

(386) 446-4210

Fax

(386) 445-7309

NPI assigned

Jan 3, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eye-Style Optical

  • Optician
  • Palm Coast, FL
  • NPI 1699826552
  NPD (past) Authorized official
• Gregory L. Kane OD PA

  • Optometrist
  • Palatka, FL
  • NPI 1760613368
  NPD (past)

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603065600000",
    "number": "1679630842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 PALM COAST PKWY SW",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321374700",
            "telephone_number": "386-446-4210",
            "fax_number": "386-445-7309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 PALM COAST PKWY SW",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321374700",
            "telephone_number": "386-446-4210",
            "fax_number": "386-445-7309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JADE",
        "name_prefix": "Mrs.",
        "credential": "L.D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-03",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "FL",
            "license": "DO5189",
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "FL",
            "license": "DO1284",
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "FL",
            "license": "DO3668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYE-MED",
            "identifier": "OP0463",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630073100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J & B Medical Transport LLC
• Susan Marie Jabs
• Alyssa Jackson
• Anita Dionne Jackson
• Donna Kay Jackson
• Jeremy Jackson
• Ronald F Jacob, DDS
• Andrew T Jacquay, DPT
• Vijay K Jain, M.D.
• Henry James, N/A

• Optician in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Optician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; 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.