Provider Demographics
NPI:1427384668
Name:JACKSON EYE ASSOCIATES, OD PA
Entity Type:Organization
Organization Name:JACKSON EYE ASSOCIATES, OD PA
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 1:1112 NEW POINTE BLVD
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4115
Practice Address - Country:US
Practice Address - Phone:910-383-0544
Practice Address - Fax:910-383-0539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty