Healthcare Provider Details

I. General information

NPI: 1528983798
Provider Name (Legal Business Name): JACKSON EYE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 EASTERN ST STE F
KINGMAN AZ
86401-5486
US

IV. Provider business mailing address

710 EASTERN ST STE F
KINGMAN AZ
86401-5486
US

V. Phone/Fax

Practice location:
  • Phone: 928-224-0536
  • Fax: 928-628-3308
Mailing address:
  • Phone: 928-224-0536
  • Fax: 928-628-3308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TODD LINCOLN JACKSON SR.
Title or Position: PRESIDENT/MANAGER
Credential: MD, MPH
Phone: 702-767-7048