Jackson, Melvin E.
Jackson, Melvin E. is an sole proprietor health care provider with primary practice located at 4642 Haygood Rd Suite 1, Virginia Beach VA 23455-5436. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Jackson, Melvin E. can be contacted via phone (757) 464-5842.Contact Information
Primary practice address
4642 Haygood Rd Suite 1
Virginia Beach VA 23455-5436
Phone: (757) 464-5842
Fax: (757) 464-4745
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 0618000174 | Virginia |
Profile Details
| NPI number | 1588657217 |
|---|---|
| LBN Legal business name | Jackson, Melvin E. |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 29th, 2005 |
| Last updated | Nov 7th, 2008 - about 16 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 | 1588657217 | NPPES |
| Virginia | MEDICAID | 9205985 | |
| Virginia | Other | 040971 | |
| Virginia | Other | 54-1390819 |
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