Active NPI
Warren Jackson, OD
- Optometrist
- Windham, ME
National Provider Identifier
1992648133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT1120
- Practice address
- 656 Roosevelt TRL
Windham, ME 04062-5271 - Phone
- (207) 389-3525
- NPI assigned
- Apr 13, 2026
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT1120 | ME | Primary |
Addresses
Primary practice location
656 Roosevelt TRL
Windham, ME 04062-5271
Mailing address
656 Roosevelt TRL
Windham, ME 04062-5271
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1776038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781395200000",
"number": "1992648133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "656 ROOSEVELT TRL",
"city": "WINDHAM",
"state": "ME",
"postal_code": "040625271"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "656 ROOSEVELT TRL",
"city": "WINDHAM",
"state": "ME",
"postal_code": "040625271",
"telephone_number": "207-389-3525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "WARREN",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-04-13",
"last_updated": "2026-06-14",
"certification_date": "2026-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "ME",
"license": "OPT1120",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Windham, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2026; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.