Jackson, Jared

Jackson, Jared is an sole proprietor health care provider with primary practice located at 3431 S Boulevard Ste 105 , Edmond OK 73013-5514. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Ophthalmology, Ambulatory Health Care Facilities / Medical Specialty, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Ophthalmology is his primary health care specialty. Jackson, Jared can be contacted via phone (405) 771-0880.

Contact Information

Primary practice address
3431 S Boulevard Ste 105 Edmond OK 73013-5514
Phone: (405) 771-0880
Fax: (405) 562-2116
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 29168 Oklahoma
Ambulatory Health Care Facilities / Medical Specialty 261QM2500X 29168 Oklahoma
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X 11016020A Indiana

Profile Details

NPI number 1730476730
LBN Legal business name Jackson, Jared
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 29th, 2011
Last updated Apr 21st, 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 1730476730 NPPES
Oklahoma MEDICAID 200752480A

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