JACKSON OPTICAL LLC (NPI# 1639361322) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639361322 |
| Entity Type | Organization |
| Organization Name | JACKSON OPTICAL LLC |
| Practice Address |
4265 Tamiami Trl Suite G Port Charlotte FL 33980-2152 |
| Practice Telephone | 9416256602 |
| Practice Fax Number | 9416250021 |
| Mailing Telephone | 9416256602 |
| Mailing Fax Number | 9416250021 |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2007-10-22 |
| Authorized Official Name | MR. STEPHEN MASON (OWNER) |
| Authorized Official Telephone | 9416256602 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 156FX1800X |
Technician/Technologist Specialization: Optician |
OE702 | FL | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | PALMETTO | 5488960001 | 01 |
| Street Address |
4265 TAMIAMI TRL SUITE G |
| City | PORT CHARLOTTE |
| State | FL |
| Zip Code | 33980-2152 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922048784 | Publix Super Markets Inc | Pharmacy | 4265 Tamiami Trl, Port Charlotte, FL 33980-2152 | 2006-06-08 |
| 1427673003 | Victoria Marie Sweet | Pharmacist | 4265 Tamiami Trl, Port Charlotte, FL 33980-2152 | 2020-06-10 |
| 1447698428 | Michael Farris | Pharmacist | 4265 Tamiami Trl, Port Charlotte, FL 33980-2152 | 2013-06-12 |
| 1164769931 | Matthew Luttrell | Pharmacist | 4265 Tamiami Trl, Port Charlotte, FL 33980-2152 | 2013-01-13 |
| 1194062257 | Pamela Elizabeth Mcdonald-dorman | Pharmacist | 4265 Tamiami Trl, Port Charlotte, FL 33980-2152 | 2013-01-09 |
| 1962676189 | Mdk Ventures L.l.c | Durable Medical Equipment & Medical Supplies | 4265 Tamiami Trl, Unit E, Port Charlotte, FL 33980-2152 | 2008-04-18 |
| 1093907784 | Stephen Mason | Technician/Technologist | 4265 Tamiami Trl, Suite G, Port Charlotte, FL 33980-2152 | 2007-08-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144699646 | Raymond B Hendricks | Custodial Care Facility | 1306 Annette St, Port Charlotte, FL 33980 | 2015-09-15 |
| 1649616517 | Anne Yvonne Clarke | Nurse's Aide | 3378 Idlewild Street, Port Charlotte, FL 33980 | 2013-05-17 |
| 1427395680 | John F Guarino Md Pa | Surgery | 4245 Kings Hwy, Unit A, Port Charlotte, FL 33980 | 2013-01-08 |
| 1497049027 | Patricia Ann Drow | Occupational Therapist | 24469 Manchester Trail, Port Charlotte, FL 33980 | 2011-05-31 |
| 1811221484 | Amanda K Huffman | Clinical Nurse Specialist | 22655 Bayshore Rd Ste 130, Port Charlotte, FL 33980 | 2009-09-29 |
| 1093967739 | Donna Olson | Nurse Practitioner | 1100 Loveland Boulevard, Port Charlotte, FL 33980 | 2008-10-14 |
| 1821278029 | Paula Marie Allison | Dietitian, Registered | 23422 Burlingame Ave, Port Charlotte, FL 33980 | 2007-11-06 |
| 1689865891 | Keith Anthony Williams | Physical Medicine & Rehabilitation | 4265 Laura Street, Port Charlotte, FL 33980 | 2007-08-05 |
| 1578685491 | Richard Michael Cocchieri | Dentist | Florida Department of Health In Charlotte County, 1100 Loveland Boulevard, Port Charlotte, FL 33980 | 2007-04-03 |
| 1417989328 | John F Guarino | Surgery | 4245 Kings Highway, Unit A, Port Charlotte, FL 33980 | 2006-07-07 |
| Find all providers in zip 33980 | ||||
| Taxonomy Code | 156FX1800X |
| Grouping | Eye and Vision Services Providers |
| Classification | Technician/Technologist |
| Specialization | Optician |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912039223 | Wal-mart Stores, Inc. | Technician/Technologist | 375 Kings Highway, Port Charlotte, FL 33983 | 2007-03-12 |
| 1093907784 | Stephen Mason | Technician/Technologist | 4265 Tamiami Trl, Suite G, Port Charlotte, FL 33980-2152 | 2007-08-16 |
| 1326147745 | Wal-mart Stores East, Lp | Technician/Technologist | 19100 Murdock Cir, Port Charlotte, FL 33948-1022 | 2006-09-22 |
| 1639278245 | Sam's Club Optical | Technician/Technologist | 17700 Murdock Cir, Port Charlotte, FL 33948-1054 | 2006-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538767405 | Michelle Mattera Starkey | Technician/Technologist | 1633 Taylor Rd # 104, Port Orange, FL 32128-6754 | 2020-10-13 |
| 1346848249 | Elizabeth Mary Howard | Technician/Technologist | 1633 Taylor Rd Unit 104, Port Orange, FL 32128-6754 | 2020-10-13 |
| 1992311492 | Conway Optical Company | Technician/Technologist | 3834 Curry Ford Rd, Orlando, FL 32806-2708 | 2020-09-20 |
| 1689283160 | Magnum Bien Aime | Technician/Technologist | 1860 N Pine Island Rd Ste 105, Plantation, FL 33322-5234 | 2020-07-30 |
| 1073121430 | Elvira R Diez | Technician/Technologist | 950 Bluewood Ter, Weston, FL 33327-2049 | 2020-07-21 |
| 1598373219 | Jocelyn Dorfils | Technician/Technologist | 4135 Dr Martin Luther King Blvd, Fort Myers, FL 33916-4809 | 2020-07-20 |
| 1376161000 | Carla Stocker | Technician/Technologist | 7410 Daetwyler Dr, Orlando, FL 32812-3726 | 2020-07-09 |
| 1306464292 | Christian Gonzalez | Technician/Technologist | 4135 Dr Martin Luther King Blvd # G16, Fort Myers, FL 33916-4809 | 2020-07-08 |
| 1245867902 | Cindy Perry Toepfer | Technician/Technologist | 264 Tamiami Trl S, Venice, FL 34285-2419 | 2020-03-24 |
| 1518593367 | Sand Vision LLC | Technician/Technologist | 706 Sw Pine Island Rd # 102, Cape Coral, FL 33991 | 2020-03-12 |
| Find all providers with the same taxonomy | ||||
| City | PORT CHARLOTTE |
| Zip Code | 33980 |
Please comment or provide details below to improve the information on JACKSON OPTICAL LLC.
| 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.