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General NPI Number Information
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NPI Number | 1205819638
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Entity Type | Individual
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Provider Name | REBECCA KATHERINE PITT JACKSON OD
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Gender | Female
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 03/19/2008
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Provider Practice Location Address
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Address Line | 2510 S RESERVE ST
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City | MISSOULA
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State | MT
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Zip | 59801-7546
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Country | US
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Telephone | 406-251-4579
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Fax | 406-251-3285
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Provider Business Mailing Address
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Address Line | 2510 S RESERVE ST
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City | MISSOULA
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State | MT
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Zip | 59801-7546
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Country | US
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Telephone | 406-531-0271
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 716
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License Number State | MT
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