Devin Jackson

Primary specialty

OptometristTaxonomy code 152W00000X

License

0003396 Issued in CO

Practice address

3958 N Academy Blvd Ste 108
Colorado Springs, CO 80917-5911

Phone

(719) 999-8404

Fax

(719) 999-8402

NPI assigned

Jul 4, 2018

Last updated

Oct 17, 2019By 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 CO

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

Southern College of Optometry, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Evergreen Optometry, PLLCGroup PAC ID 1759773880, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Evergreen Optometry, PLLC

  • Optometrist
  • Colorado Springs, CO
  • NPI 1801561634
  Medicare reassignment Care Compare group NPD
• Blair Vision Care, LLC

  • Optometrist
  • Canon City, CO
  • NPI 1134436728
  Medicare reassignment NPD
• Optom-Eyes,LLC

  dba Optom-Eye,LLC

  • Clinic/Center
  • Colorado Springs, CO
  • NPI 1619624632
  Medicare reassignment NPD
• Peak View Optometry Fort Carson, LLC

  • Optometrist
  • Fort Carson, CO
  • NPI 1194327148
  Medicare reassignment NPD
• Blair Vision Care, LLC

  • Optometrist
  • Colorado Springs, CO
  • NPI 1396386843
  NPD
• Optom-Eyes, Inc.

  • Optometrist
  • Colorado Springs, CO
  • NPI 1730215500
  NPD (past)

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

{
    "created_epoch": "1530662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571270400000",
    "number": "1720574544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3425 AUSTIN BLUFFS PKWY STE 108",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809185723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3958 N ACADEMY BLVD STE 108",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809175911",
            "telephone_number": "719-999-8404",
            "fax_number": "719-999-8402"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 Main St",
            "address_purpose": "LOCATION",
            "city": "Canon City",
            "state": "CO",
            "postal_code": "812123739",
            "country_code": "US",
            "telephone_number": "719-431-6434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DEVIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-04",
        "last_updated": "2019-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "0003396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charity L Jackson, M.D.
• Chase Bradford Jackson, DO
• Curtis Gerard Jackson, PTA, CNA
• Danica Jackson
• David Wayne Jackson II, MED, BCBA
• Holley Jackson
• Isabella Jackson
• Isaiah Jackson
• Keith Lynn Jackson II, MD
• Kelsey Jackson

• Optometrist in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Optometrist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2019; 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.