Justin Jackman, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

8188T Issued in TX

Practice address

4015 Penbrook St
Odessa, TX 79762-5917

Phone

(432) 362-3133

Fax

(432) 362-4818

NPI assigned

Jul 19, 2013

Last updated

Jul 19, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 TX, UT, NV3 enrollments

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 3

Specialty

Optometry

Education

Southern California College of Optometry, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jason a Ahee MD PCGroup PAC ID 6800891722, 6 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Odessa Vision Center PLLC

  dba Odessa Vision Center

  • Optometrist
  • Odessa, TX
  • NPI 1578747275
  Medicare reassignment NPD Authorized official
• Jason a Ahee MD PC

  dba Zion Eye Institute

  • Ophthalmology Physician
  • St George, UT
  • NPI 1649276957

  NV, Optometrist

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1374192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374192000000",
    "number": "1982046967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4015 PENBROOK ST",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797625917",
            "telephone_number": "432-362-3133",
            "fax_number": "432-362-4818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4015 PENBROOK ST",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797625917",
            "telephone_number": "432-362-3133",
            "fax_number": "432-362-4818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKMAN",
        "first_name": "JUSTIN",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-19",
        "last_updated": "2013-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "8188T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa Ann Isom
• J a Mayans MD PA (Southwest Retina Eye Center)
• J&B Senior and Disabled Services
• Ali Jabur, MD
• Razzak Jabur, M.D.
• Christopher R Jackson
• Gary Chase Jackson, O.D.
• Jean Petrilla Jackson, MA, LPC
• Rawnak Jahan
• Madhuri Jakkam Setty, MD

• Optometrist in Odessa, TX
• Providers in Odessa, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2013; 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.