Jackson, John Mark
Jackson, John Mark is an individual health care provider with primary practice located at 1225 Madison Ave , Memphis TN 38104. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Jackson, John Mark can be contacted via phone (901) 722-3250.Contact Information
Primary practice address
1225 Madison Ave
Memphis TN 38104
Phone: (901) 722-3250
Fax: (901) 722-3347
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2288 | Tennessee |
Profile Details
| NPI number | 1992798193 |
|---|---|
| LBN Legal business name | Jackson, John Mark |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 24th, 2005 |
| Last updated | Mar 7th, 2023 - about 3 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 | 1992798193 | NPPES |
| Tennessee | MEDICAID | 3944619 | |
| Tennessee | Other | 2288 |
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