Russell B Jackson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

375344-9934 Issued in UT

Practice address

210 S 100 E
Fillmore, UT 84631-2500

Phone

(435) 743-6572

Fax

(435) 743-5558

NPI assigned

Jul 22, 2005

Last updated

Dec 5, 2007By 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Jackson Eye Care, Inc

  dba Russell B Jackson OD

  • Optometrist
  • Fillmore, UT
  • NPI 1912181967
  NPD (past) Authorized official
• Michael F. Pingree MD PC

  • Ophthalmic Technician/Technologist
  • West Valley City, UT
  • NPI 1831387125

  Optometrist

  NPD (past)
• Standard Optical Co

  • Optometrist
  • Logan, UT
  • NPI 1215038724
  NPD (past)
• Standard Optical Co

  • Optometrist
  • Roy, UT
  • NPI 1396832655
  NPD (past)
• Standard Optical Co

  • Optometrist
  • Salt Lake City, UT
  • NPI 1962599290
  NPD (past)
• Standard Optical Company

  • Optometrist
  • West Point, UT
  • NPI 1659958841
  NPD (past)

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

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196812800000",
    "number": "1922008663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 73",
            "city": "FILLMORE",
            "state": "UT",
            "postal_code": "846310073",
            "telephone_number": "435-743-6572",
            "fax_number": "435-743-5558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S 100 E",
            "city": "FILLMORE",
            "state": "UT",
            "postal_code": "846312500",
            "telephone_number": "435-743-6572",
            "fax_number": "435-743-5558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "RUSSELL",
        "middle_name": "B",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-22",
        "last_updated": "2007-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "375344-9934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "37534499300001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ihc Health Services, Inc (Intermountain Homecare Home Health Fillmore)
• Ihc Health Services, Inc. (Fillmore Clinic)
• Ihc Health Services, Inc. (Intermountain Health Fillmore Community Hospital)
• Jackson Eye Care, Inc (Russell B Jackson OD)
• Brent D Jackson, MD
• Jacob D Finlinson, D.D.S, LLC
• Tonia Jorgensen, PTA
• Randleman Pearsall Keltner, DPT
• Shianna Markward
• Leona Mae Moat, ATC, MED

• Optometrist in Fillmore, UT
• Providers in Fillmore, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 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.

Verify at the official NPI Registry.