Provider Demographics
NPI:1790350866
Name:CAREY, JACKSON DAVID (OD)
Entity Type:Individual
Prefix:MR
First Name:JACKSON
Middle Name:DAVID
Last Name:CAREY
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 1:1210 CHAMBERS RD APT 305B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-1726
Mailing Address - Country:US
Mailing Address - Phone:304-914-5290
Mailing Address - Fax:
Practice Address - Street 1:5965 E BROAD ST STE 480
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1562
Practice Address - Country:US
Practice Address - Phone:614-751-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006946152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist