Provider Demographics
NPI:1740790336
Name:JACKMAN EYE
Entity Type:Organization
Organization Name:JACKMAN EYE
Other - Org Name:MD JACKMAN OD AND ASSOCIATES, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:LUCE
Authorized Official - Last Name:HUSER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-323-6996
Mailing Address - Street 1:1000 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-4008
Mailing Address - Country:US
Mailing Address - Phone:512-323-6996
Mailing Address - Fax:512-452-0015
Practice Address - Street 1:1000 W 39TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4008
Practice Address - Country:US
Practice Address - Phone:512-323-6996
Practice Address - Fax:512-452-0015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:M D JACKMAN OD & ASSOCIATES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8073-TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty