MEDICARE: KRISTINA YVETTE JACKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	691-S	OH
2	237700000X	Hearing Instrument Specialist	03151	OH

General Provider Information

NPI Number	:	1083042345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA YVETTE JACKSON

Provider Business Mailing Address
First Line	:	11285 DRAKE RD
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-5405
Country	:	US
Telephone Number	:	440-305-2822
Fax Number	:

Provider Business Practice Location Address
First Line	:	6548 ROYALTON RD STE 101
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-4976
Country	:	US
Telephone Number	:	440-305-2822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2013
Last Update Date	:	02/15/2024

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Directions to “ KRISTINA YVETTE JACKSON ” Practice Location

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