Provider Demographics
NPI:1609377423
Name:DEBRY JACKSON OPHTHALMOLOGY PLLC
Entity Type:Organization
Organization Name:DEBRY JACKSON OPHTHALMOLOGY PLLC
Other - Org Name:DEBRY JACKSON OPHTHALMOLOGY PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LECKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-825-2085
Mailing Address - Street 1:2390 W HORIZON RIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5084
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2390 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5084
Practice Address - Country:US
Practice Address - Phone:702-825-2085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty