Provider Demographics
NPI:1730319146
Name:JACKMAN, CHRISTOPHER ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ROBERT
Last Name:JACKMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 W WHITE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-2616
Mailing Address - Country:US
Mailing Address - Phone:972-924-8889
Mailing Address - Fax:972-924-8555
Practice Address - Street 1:805 W WHITE ST STE 100
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-2616
Practice Address - Country:US
Practice Address - Phone:972-924-8889
Practice Address - Fax:972-924-8555
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7402T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F23962Medicare PIN
TX6340670001Medicare NSC