Jackson, Michael Wayne
Jackson, Michael Wayne is an individual health care provider with primary practice located at 1741 Broadway , Oakland CA 94612-2105. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Jackson, Michael Wayne can be contacted via phone (510) 835-8344.Contact Information
Primary practice address
1741 Broadway
Oakland CA 94612-2105
Phone: (510) 835-8344
Fax: (510) 835-8346
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 6056T | California |
Profile Details
| NPI number | 1174593388 |
|---|---|
| LBN Legal business name | Jackson, Michael Wayne |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 23rd, 2006 |
| Last updated | Jul 8th, 2007 - about 17 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 | 1174593388 | NPPES |
| California | MEDICAID | SD0060560 |
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