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General NPI Number Information
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NPI Number | 1811328123
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Entity Type | Organization
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Legal Business Name | JAY JACKSON OD PC
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Dates
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Enumeration Date | 12/12/2013
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Last Update Date | 12/12/2013
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Provider Practice Location Address
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Address Line | 5500 ABERCORN ST STE 24 12 OAKS SHOPPING CENTER
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City | SAVANNAH
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State | GA
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Zip | 31405-6917
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Country | US
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Telephone | 912-352-3478
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Fax |
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Provider Business Mailing Address
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Address Line | 23 MONASTERY RD
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City | SAVANNAH
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State | GA
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Zip | 31411-1737
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Country | US
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Telephone | 912-398-0418
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAY JACKSON
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Credential | O.D.
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Telephone | 912-352-3478
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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 | OPT001191
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License Number State | GA
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