Provider Demographics
NPI:1710410717
Name:JACKSON, RACHELLE MORIAH (OD)
Entity Type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:MORIAH
Last Name:JACKSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4167 FRANKLIN RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-4257
Mailing Address - Country:US
Mailing Address - Phone:615-295-8585
Mailing Address - Fax:
Practice Address - Street 1:4167 FRANKLIN RD STE 2A
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-4257
Practice Address - Country:US
Practice Address - Phone:615-295-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN3351152W00000X
TN3351152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist