Active NPI
Don Jobe Jackson, MD
- Ophthalmology Physician
- Columbia, SC
National Provider Identifier
1811950215
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 11095
- Practice address
- 1920 Pickens St
Columbia, SC 29201 - Phone
- (803) 779-3070
- Fax
- (803) 771-7639
- NPI assigned
- Apr 8, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 11095 | SC | Primary |
Addresses
Primary practice location
1920 Pickens St
Columbia, SC 29201
Mailing address
PO Box 60371
Charlotte, NC 28260-0371
Phone (803) 779-3070
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110953 | Medicaid | SC |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11095 | SC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Columbia Eye Clinic PA | Ophthalmology | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191974400000",
"number": "1811950215",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 60371",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282600371",
"telephone_number": "803-779-3070",
"fax_number": "803-771-7639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1920 PICKENS ST",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "29201",
"telephone_number": "803-779-3070",
"fax_number": "803-771-7639"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DON",
"middle_name": "JOBE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-08",
"last_updated": "2007-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "SC",
"license": "11095",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110953",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.