Jackson Oculofacial and Cosmetic Surgery PA

Primary specialty

Ophthalmic Plastic and Reconstructive Surgery PhysicianTaxonomy code 207WX0200X

Legal business name

JACKSON OCULOFACIAL AND COSMETIC SURGERY PA

Practice address

3636 Greenbriar Dr Ste 2a
Houston, TX 77098-4004

Phone

(832) 899-5699

NPI assigned

Aug 11, 2020

Organization subpart

No

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

Authorized official

Name

Jenell Jackson, MD

Title

Managing Physician

Phone

(404) 790-7628

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1597104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644969600000",
    "number": "1689285819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1213 HERMANN DR STE 540",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770047089",
            "telephone_number": "404-790-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3636 GREENBRIAR DR STE 2A",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770984004",
            "telephone_number": "832-899-5699"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1213 Hermann Dr Ste 540",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770047089",
            "country_code": "US",
            "telephone_number": "404-790-7628",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JACKSON OCULOFACIAL AND COSMETIC SURGERY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-11",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JENELL",
        "authorized_official_title_or_position": "MANAGING PHYSICIAN",
        "authorized_official_telephone_number": "404-790-7628",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207WX0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kemberlee J Jack, CCC-SLP
• Robert Alan Jack II, M.D.
• Keri Lynne Jackman, LCSW
• Jackson Home Healthcare Inc
• Benyta Gail Jackson Nunley, RN
• Jackson Street Surgical Center LLC
• Joanna Jackson-Arinze, MSA DEGREE
• Chanell Monique Jackson-Blanton, PTA
• Heather Jackson-Brown, LCSW
• Lashonda Michill Jackson-Dean, DM,MBA,LHRP,CPT,CIVT

• Ophthalmic Plastic and Reconstructive Surgery Physician in Houston, TX
• Providers in Houston, TX by specialty
• Ophthalmic Plastic and Reconstructive Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; 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.