Jackson, Autumn H

Jackson, Autumn H is an individual health care provider with primary practice located at 73 Valley Rd , Middletown RI 02842-5234. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Jackson, Autumn H can be contacted via phone (401) 847-1040.

Contact Information

Primary practice address
73 Valley Rd Middletown RI 02842-5234
Phone: (401) 847-1040
Fax: (401) 847-1049
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 4642 Massachusetts
Eye and Vision Services Providers / Optometrist 152W00000X ODTA00538 Rhode Island

Profile Details

NPI number 1477739100
LBN Legal business name Jackson, Autumn H
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 11th, 2008
Last updated Sep 21st, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1477739100 NPPES
Massachusetts MEDICAID 0718769
Massachusetts MEDICAID AJ73813

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