MEDICARE: JACKSON VISION CENTER, LLC

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	152W00000X	Optometrist		WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598881336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON VISION CENTER, LLC

Provider Business Mailing Address
First Line	:	W194N16747 EAGLE DR
Second Line	:	SUITE N
City	:	JACKSON
State	:	WI
Zip	:	53037-9797
Country	:	US
Telephone Number	:	262-677-4313
Fax Number	:	262-677-4396

Provider Business Practice Location Address
First Line	:	W194N16747 EAGLE DR
Second Line	:	SUITE N
City	:	JACKSON
State	:	WI
Zip	:	53037-9797
Country	:	US
Telephone Number	:	262-677-4313
Fax Number	:	262-677-4396

Authorized Official
Title or Position	:	OWNER
Name	:	ZHALEH BARARI
Credential	:	O.D.
Telephone Number	:	262-677-4313

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	11/03/2012

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Directions to “JACKSON VISION CENTER, LLC ” Practice Location

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