Michael Wayne Jackson O.D.

NPI 1174593388 - Optometrist - 152W00000X

NPI Details
NPI 1174593388
Gender Male
Enumeration Date 01/23/2006
Last Updated 07/08/2007
Entity Type Individual
Active Over 11 years ago
Practice Location
1741 BROADWAY
OAKLAND CA, 94612-2105, US
Phone (510) 835-8344
Fax (510) 835-8346
Business Location
1741 BROADWAY
OAKLAND CA, 94612-2105, US
Phone (510) 835-8344
Fax (510) 835-8346
Toxanomy
Taxonomy Code 152W00000X
License State California
License Number 6056T
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According to our database, Dr. Michael Wayne Jackson O.D. NPI is 1174593388, taxonomy code is 152W00000X and license number is 6056T, license state is located at California. Michael Wayne Jackson O.D. physically located at 1741 Broadway, Oakland CA, 94612-2105. NPI Number Michael Wayne Jackson O.D. has the Individual type.

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1174593388 NPI number is provided on an as is basis without warranty of any kind. 1174593388 is maintained by the National Plan & Provider Enumeration System. The contents of Michael Wayne Jackson O.D. are for informational purposes only.