Provider Demographics
NPI:1215019278
Name:JACKSON, OSCAR B JR (MD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:B
Last Name:JACKSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3509 LAWTON AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6112
Mailing Address - Country:US
Mailing Address - Phone:512-451-0234
Mailing Address - Fax:512-451-3566
Practice Address - Street 1:3509 LAWTON AVENUE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6112
Practice Address - Country:US
Practice Address - Phone:512-451-0234
Practice Address - Fax:512-451-3566
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2008-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXD8288207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX891200OtherBLUE CROSS BLUE SHIELD
TX134810404Medicaid
TX134810404Medicaid
TX891200Medicare PIN