RANDOLPH THOMAS JACKSON


Address: 11010 Haskell Ave, Kansas City, KS 66109-8500
Phone: 8164781230

RANDOLPH THOMAS JACKSON (NPI# 1457310518) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1457310518
Entity Type Individual
Full Name RANDOLPH THOMAS JACKSON
Credential M.D.
Practice Address 11010 Haskell Ave
Kansas City
KS 66109-8500
Mailing Address 4801 S Cliff Ave
Suite 100
Independence
MO 64055-7015
Practice Telephone 8164781230
Practice Fax Number 8163504166
Mailing Telephone 8163504536
Mailing Fax Number 8163504585
Enumeration Date 2006-03-18
Last Update Date 2009-05-07
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 207W00000X Ophthalmology 2006012805 MO Allopathic & Osteopathic Physicians
Y 207W00000X Ophthalmology 31896 KS Allopathic & Osteopathic Physicians
N 207W00000X Ophthalmology 10506 MT Allopathic & Osteopathic Physicians
N 207W00000X Ophthalmology 46566 MN Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
KS RAILROAD MEDICARE P00685107 01

Office Location

Street Address 11010 HASKELL AVE
City KANSAS CITY
State KS
Zip Code 66109-8500

Providers in the same location

NPI Name Taxonomy Address Enumeration
1346489747 Eye Care, Pa Eyewear Supplier (Equipment, not the service) 11010 Haskell Ave, Kansas City, KS 66109-8500 2009-02-10

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1154796688 Lance Miller Pharmacist 10510 Parallel, Kansas City, KS 66109 2015-12-09
1386016293 Tara Newton Community Health Worker 2821 N 91 St, Kansas City, KS 66109 2015-10-30
1952726473 Dia L Herr Clinic/Center 2617 N. 69th Street, Kansas City, KS 66109 2014-02-20
1033559570 Legends Dental Group, P.a. Dentist 10818 Parallel Parkway, Kansas City, KS 66109 2013-06-28
1215277694 Kristin Kathleen Porter Dietitian, Registered 10124 Hutton Road, Kansas City, KS 66109 2013-02-22
1932459229 Sams West, Inc Technician/Technologist 10510 Parrallel Pkwy, Kansas City, KS 66109 2012-09-13
1356642276 Anjali Doshi Dentist 10818 Parallel Pkwy, Kansas City, KS 66109 2010-11-09
1841411675 Wendy Ann Brakhage Chiropractor 2300 Hutton Road, Suite 101, Kansas City, KS 66109 2007-05-01
1205953742 Lisa R Gonzales Dentist 10203 Leavenworth Road, Kansas City, KS 66109 2007-03-22
1497898290 Shannon R Margherio Physical Therapist 1801 N 98th Street, Kansas City, KS 66109 2007-02-14
Find all providers in zip 66109

Taxonomy Information

Taxonomy Code 207W00000X
Grouping Allopathic & Osteopathic Physicians
Classification Ophthalmology

Taxonomy Definition

An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source]
- Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1003466897 Mcelhinney Eye Care, Pa Ophthalmology 1004 Carondelet Dr Ste 405, Kansas City, MO 64114-4801 2019-09-13
1003250606 Manuel David Camejo Ophthalmology 4320 Wornall Rd Ste 220, Kansas City, MO 64111-5954 2013-04-25
1235366139 Allen G Parelman Ophthalmology 402 W 50th St, Kansas City, MO 64112-2528 2009-06-17
1407929417 Tauber Eye Center LLC Ophthalmology 4400 Broadway St Ste 202, Kansas City, MO 64111-3342 2006-11-16
1265532642 Jerry William Cook Ophthalmology 7400 Nw Whipple Ln, Kansas City, MO 64152-1856 2006-09-25
1356357230 Gurinder Singh Ophthalmology 155 South 18th Street, Suite 220, Kansas City, KS 66102 2006-07-31
1144265075 Perfect Sense Eye Center PC Ophthalmology 211 Ne 54th, Ste 202, Kansas City, MO 64118-4337 2006-06-17
1447204441 Amy E Ciccio Ophthalmology 7701 State Line Rd, Kansas City, MO 64114-1635 2006-05-22
1245207398 Louis Monaco II Ophthalmology 2301 Holmes, Kansas City, MO 64018-1192 2006-03-07
1174525208 Karl D Hendricks Ophthalmology 8919 Parallel Pkwy, Ste 226, Kansas City, KS 66112-1655 2005-06-01
Find all providers in KANSAS CITY

Competitor

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City KANSAS CITY
Zip Code 66109

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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