Alex Mitchell Jackson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3379 Issued in TN

Practice address

2699 Townsend CT
Clarksville, TN 37043-6487

Phone

(931) 647-8417

Fax

(931) 648-4435

NPI assigned

Jul 17, 2017

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

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, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lynn and York Optometrists PCGroup PAC ID 5395837926, 5 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

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 and National Provider Directory roles.

• Lynn & York, Optometrists, PC

  dba Northfield Eye Care

  • Optometrist
  • Clarksville, TN
  • NPI 1346449733
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1500249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581379200000",
    "number": "1851814396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2699 TOWNSEND CT",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370436487",
            "telephone_number": "931-647-8417",
            "fax_number": "931-648-4435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2699 TOWNSEND CT",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370436487",
            "telephone_number": "931-647-8417",
            "fax_number": "931-648-4435"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3929 Lamar St",
            "address_2": "Ste B",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "TN",
            "postal_code": "37040",
            "country_code": "US",
            "telephone_number": "931-245-3937 x203",
            "fax_number": "931-647-0354",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ALEX",
        "middle_name": "MITCHELL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-17",
        "last_updated": "2020-02-11",
        "certification_date": "2020-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "3379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q009057",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sabella Love Israel
• Mary Ittner
• Sarah Ivy, SLPA
• J and J Medical Transport
• J and J Transportation
• Alice Marie Jackson, APN
• Alyssa Jackson, OD
• Azia Jackson, LPC-MHSP
• Chantella Jackson
• Deirdre Renee' Jackson, PHD LCMHCS LPC NCC

• Optometrist in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2020; 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.