Provider Demographics
NPI:1184671489
Name:JACKSON EYE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:JACKSON EYE ASSOCIATES PLLC
Other - Org Name:JACKSON EYE ASSOCIATES, CLINTON OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-353-2020
Mailing Address - Street 1:1190 N STATE ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2413
Mailing Address - Country:US
Mailing Address - Phone:601-353-2020
Mailing Address - Fax:601-714-5110
Practice Address - Street 1:102 CLINTON PKWY
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4730
Practice Address - Country:US
Practice Address - Phone:601-924-9750
Practice Address - Fax:601-925-9125
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON EYE ASSOCIATES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-30
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20061221261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03189030Medicaid
MS03189030Medicaid
MSC02972Medicare ID - Type UnspecifiedMEDICARE GROUP #