Provider Demographics
NPI:1982981734
Name:JAKSON EYECARE INC
Entity Type:Organization
Organization Name:JAKSON EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KINGA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-744-5608
Mailing Address - Street 1:1033 NE 17TH WAY
Mailing Address - Street 2:UNIT 1001
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2458
Mailing Address - Country:US
Mailing Address - Phone:727-744-5608
Mailing Address - Fax:
Practice Address - Street 1:1900 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-2230
Practice Address - Country:US
Practice Address - Phone:727-744-5608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4455152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty