Jackson, Randolph Thomas

Jackson, Randolph Thomas is an individual health care provider with primary practice located at 11010 Haskell Ave , Kansas City KS 66109-8500. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Jackson, Randolph Thomas can be contacted via phone (816) 478-1230.

Contact Information

Primary practice address
11010 Haskell Ave Kansas City KS 66109-8500
Phone: (816) 478-1230
Fax: (816) 350-4166
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 46566 Minnesota
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 10506 Montana
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 31896 Kansas
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 2006012805 Missouri

Profile Details

NPI number 1457310518
LBN Legal business name Jackson, Randolph Thomas
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 18th, 2006
Last updated May 7th, 2009 - 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457310518 NPPES
Kansas Other P00685107 RAILROAD MEDICARE

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