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General NPI Number Information
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NPI Number | 1194883017
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Entity Type | Organization
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Legal Business Name | DRS JACKSON & LEE, INC
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 06/04/2019
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Provider Practice Location Address
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Address Line | 28815 PACIFIC HWY S SUITE 2
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City | FEDERAL WAY
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State | WA
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Zip | 98003-3906
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Country | US
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Telephone | 253-941-7074
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Fax | 253-941-5079
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Provider Business Mailing Address
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Address Line | 28815 PACIFIC HWY S SUITE 2
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City | FEDERAL WAY
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State | WA
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Zip | 98003-3906
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Country | US
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Telephone | 253-941-7074
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Fax | 253-941-5079
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Authorized Official
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Title or Position | OWNER
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Name | DR. DUANE L JACKSON II
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Credential | O.D.
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Telephone | 253-941-7074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD00002039
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD00002095
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License Number State | WA
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