Mark D Jackson OD

NPI 1023015005 - Optometrist - 152W00000X

NPI Details
NPI 1023015005
Gender Male
Enumeration Date 07/05/2005
Last Updated 10/19/2011
Entity Type Individual
Active Over 11 years ago
Practice Location
1250 E MAGNOLIA ST
FORT COLLINS CO, 80524-2702, US
Phone (970) 224-0606
Fax (970) 493-9309
Business Location
1250 E MAGNOLIA ST
FORT COLLINS CO, 80524-2702, US
Phone (970) 224-0606
Fax (970) 493-9309
Toxanomy
Taxonomy Code 152W00000X
License State Colorado
License Number 2187
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According to our database, Dr. Mark D Jackson OD NPI is 1023015005, taxonomy code is 152W00000X and license number is 2187, license state is located at Colorado. Mark D Jackson OD physically located at 1250 E Magnolia St, Fort Collins CO, 80524-2702. NPI Number Mark D Jackson OD has the Individual type.

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1023015005 NPI number is provided on an as is basis without warranty of any kind. 1023015005 is maintained by the National Plan & Provider Enumeration System. The contents of Mark D Jackson OD are for informational purposes only.