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:
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Health care specialties

SpecialtyCodeLicense #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 18 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 1588657217 NPPES
Virginia MEDICAID 9205985
Virginia Other 040971
Virginia Other 54-1390819

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