Jackson, Jade

Jackson, Jade is an individual health care provider with primary practice located at 1240 Palm Coast Pkwy Sw , Palm Coast FL 32137-4700. She recently has only one registered license in Eye and Vision Services Providers / Optician, which is considered as her primary health care specialty. Jackson, Jade can be contacted via phone (386) 446-4210.

Contact Information

Primary practice address
1240 Palm Coast Pkwy Sw Palm Coast FL 32137-4700
Phone: (386) 446-4210
Fax: (386) 445-7309
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optician 156FX1800X DO5189 Florida
Eye and Vision Services Providers / Optician 156FX1800X DO1284 Florida
Eye and Vision Services Providers / Optician 156FX1800X DO3668 Florida

Profile Details

NPI number 1679630842
LBN Legal business name Jackson, Jade
Credentials L.D.O
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 3rd, 2007
Last updated Oct 19th, 2020 - about 4 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 1679630842 NPPES
Florida Other OP0463 EYE-MED
Florida MEDICAID 630073100 EYE-MED

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