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General NPI Number Information
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NPI Number | 1528983798
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Entity Type | Organization
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Legal Business Name | JACKSON EYE CENTER PLLC
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Dates
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Enumeration Date | 08/13/2026
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Last Update Date | 08/13/2026
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Provider Practice Location Address
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Address Line | 710 EASTERN ST STE F
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City | KINGMAN
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State | AZ
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Zip | 86401-5486
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Country | US
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Telephone | 928-224-0536
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Fax | 928-628-3308
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Provider Business Mailing Address
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Address Line | 710 EASTERN ST STE F
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City | KINGMAN
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State | AZ
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Zip | 86401-5486
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Country | US
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Telephone | 928-224-0536
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Fax | 928-628-3308
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Authorized Official
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Title or Position | PRESIDENT/MANAGER
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Name | DR. TODD LINCOLN JACKSON SR.
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Credential | MD, MPH
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Telephone | 702-767-7048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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