Provider Demographics
NPI:1356649362
Name:JACKSON EYE ASSOCIATES
Entity Type:Organization
Organization Name:JACKSON EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:CLABBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-793-1157
Mailing Address - Street 1:5135 CAROLINA BEACH RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2516
Mailing Address - Country:US
Mailing Address - Phone:910-793-1157
Mailing Address - Fax:910-793-1158
Practice Address - Street 1:3001 CALVARY DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-2801
Practice Address - Country:US
Practice Address - Phone:919-874-0154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty