Jackson, Lee Sa B.
Jackson, Lee Sa B. is an individual health care provider with primary practice located at 4824 E Baseline Rd Suite 110, Mesa AZ 85206-4676. She recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as her primary health care specialty. Jackson, Lee Sa B. can be contacted via phone (480) 615-2020.Contact Information
Primary practice address
4824 E Baseline Rd Suite 110
Mesa AZ 85206-4676
Phone: (480) 615-2020
Fax: (480) 219-9957
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 25793 | Arizona |
Profile Details
| NPI number | 1306837042 |
|---|---|
| LBN Legal business name | Jackson, Lee Sa B. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 2nd, 2005 |
| Last updated | Dec 28th, 2016 - about 9 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306837042 | NPPES |
| Arizona | MEDICAID | 404731 |
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