MEDICARE: LEIGH 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	156FX1700X	Ocularist

General Provider Information

NPI Number	:	1891505822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIGH JACKSON

Provider Business Mailing Address
First Line	:	1455 JANIE AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37216-2820
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1455 JANIE AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37216-2820
Country	:	US
Telephone Number	:	423-114-6732
Fax Number	:

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

Provider Enumeration Date	:	01/11/2025
Last Update Date	:	01/11/2025

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Directions to “ LEIGH JACKSON ” Practice Location

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