Jacksonville Vision Clinic Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

3036ATI Issued in OR

Legal business name

JACKSONVILLE VISION CLINIC INC

Practice address

950 N 5TH St
Jacksonville, OR 97530-9016

Phone

(541) 899-2020

Fax

(541) 899-1481

NPI assigned

May 21, 2009

Organization subpart

No

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

Authorized official

Name

Julie Danielson, O.D.NPI 1710979240

Title

Optometrist

Phone

(541) 899-2020

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Julie D. Danielson, OD

  • Optometrist
  • Jacksonville, OR
  • NPI 1710979240
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1242864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336003200000",
    "number": "1891920674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 N 5TH ST",
            "city": "JACKSONVILLE",
            "state": "OR",
            "postal_code": "975309016",
            "telephone_number": "541-899-2020",
            "fax_number": "541-899-1481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 N 5TH ST",
            "city": "JACKSONVILLE",
            "state": "OR",
            "postal_code": "975309016",
            "telephone_number": "541-899-2020",
            "fax_number": "541-899-1481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE VISION CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-21",
        "last_updated": "2012-05-03",
        "status": "A",
        "authorized_official_last_name": "DANIELSON",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "541-899-2020",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3036ATI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "210539",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J-Well Pilates Rehab Studio
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• Jacksonville Natural Health Pharmacy
• Jacksonville Pharmacy LLC
• Jacksonville Pharmacy, Inc.
• James Kenneth Johnson, R.PH.
• Yael Jones
• Owen David Jurling, LAC
• Daniel Kaylin, D.D.S.
• Tommie Janae Kell, EPDH

• Optometrist in Jacksonville, OR
• Providers in Jacksonville, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.