Provider Demographics
NPI:1831329309
Name:LEVER, JACKSON (MD)
Entity type:Individual
Prefix:
First Name:JACKSON
Middle Name:
Last Name:LEVER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:875 COUNTRY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2200
Mailing Address - Country:US
Mailing Address - Phone:801-399-1149
Mailing Address - Fax:801-399-0271
Practice Address - Street 1:875 COUNTRY HILLS DR
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2200
Practice Address - Country:US
Practice Address - Phone:801-399-1149
Practice Address - Fax:801-399-0271
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2018-04-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301094618207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology