JARED JACKSON (NPI# 1730476730) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730476730 |
| Entity Type | Individual |
| Full Name | JARED JACKSON |
| Credential | M.D. |
| Practice Address |
3431 S Boulevard Ste 105 Edmond OK 73013-5514 |
| Mailing Address |
Po Box 1803 Edmond OK 73083-1803 |
| Practice Telephone | 4057710880 |
| Practice Fax Number | 4055622116 |
| Mailing Telephone | 4054184800 |
| Mailing Fax Number | 4054184820 |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2020-04-21 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207W00000X | Ophthalmology | 29168 | OK | Allopathic & Osteopathic Physicians |
| N | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
29168 | OK | Ambulatory Health Care Facilities |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | 11016020A | IN | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 200752480A | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2150 S Douglas Blvd Ste C, Midwest City, OK 731306200 | 4057710880 | 4057414388 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902184732 | Jared A Jackson | Psychologist | 68-121 Au St, 306, Waialua, HI 96791-9453 | 2011-07-27 |
| Street Address |
3431 S BOULEVARD STE 105 |
| City | EDMOND |
| State | OK |
| Zip Code | 73013-5514 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669038709 | Irina Krupin | Optometrist | 3431 S Boulevard Ste 105, Edmond, OK 73013-5514 | 2019-05-14 |
| 1427556166 | Eye Care Specialists of Oklahoma Pllc | Clinic/Center | 3431 S Boulevard Ste 105, Edmond, OK 73013 | 2018-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407461866 | Alison Church-pugh | Case Manager/Care Coordinator | 1441 Kelley Pointe Pkwy, Edmond, OK 73013 | 2020-09-12 |
| 1699395343 | Dental Specialists of Edmond | Dentist | 16430 Muirfield Pl, Edmond, OK 73013 | 2020-04-23 |
| 1104477215 | Kammerer Richey LLC | Nurse Practitioner | 902 Nw 139th Street Parway, Edmond, OK 73013 | 2019-09-20 |
| 1811459191 | Peak Movement Centre, Pllc | Clinic/Center | 13816 Santa Fe Crossing Dr, Edmond, OK 73013 | 2019-04-04 |
| 1851858492 | Luma Hilal | Pharmacist | 2228 Nw 15th Terrace, Edmond, OK 73013 | 2019-03-01 |
| 1578031571 | Oklahoma Wellness Group LLC | Internal Medicine | 14101 North Esatern Avenue Suite B, Edmond, OK 73013 | 2018-11-07 |
| 1477034395 | Specialty Care Pediatrics, Inc. | Home Health | 2256 Nw 164th Street, Edmond, OK 73013 | 2018-08-28 |
| 1972083921 | Pooja Bhakta | Physician Assistant | Stanbro Healthcare Group LLC, 2000 E. 15th St., Suite 400-a, Edmond, OK 73013 | 2018-08-20 |
| 1417460577 | Oklahoma Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 15103 N Macarthur Blvd, Oklahoma City, OK 73013 | 2017-11-13 |
| 1356879753 | Shawn Smith Optimal Pt and Performance, Pllc | Physical Therapist | 336 Ne 145th Pl, Edmond, OK 73013 | 2017-05-30 |
| Find all providers in zip 73013 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| 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. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154709970 | Vincent David Venincasa | Ophthalmology | 920 S Bryant Ave Ste 100, Edmond, OK 73034-5803 | 2015-05-13 |
| 1811284946 | Retina Vitreous Center, Pllc | Ophthalmology | 1008 Nw 139th Street Parkway, Edmond, OK 73013-9791 | 2011-07-10 |
| 1306904123 | Erin L Holloman | Ophthalmology | 16315 N May Ave, Edmond, OK 73013-8892 | 2006-12-05 |
| 1558435099 | Jeffrey T Shaver PC | Ophthalmology | 3840 S Boulevard, Suite 101, Edmond, OK 73013-5478 | 2006-11-17 |
| 1205949609 | Edmond Regional Eye Associates Inc | Ophthalmology | 920 S Bryant, Ste 100, Edmond, OK 73034 | 2006-08-17 |
| 1588671408 | Virgil Jerry Shepherd | Ophthalmology | 3431 S Boulevard, Suite 106, Edmond, OK 73013 | 2006-08-02 |
| 1780634782 | Ryan Ridges | Ophthalmology | 1008 Nw 139th Street Pkwy, Edmond, OK 73013-9791 | 2006-05-11 |
| 1124088067 | Thomas C Wolf | Ophthalmology | 3431 S Boulevard St, Suite 106, Edmond, OK 73013-5475 | 2006-03-24 |
| 1073582409 | Jeffrey T Shaver | Ophthalmology | 3840 South Boulevard, Suite 101, Edmond, OK 73013-5478 | 2006-03-16 |
| 1053388504 | Laura Sarfatis Miles | Ophthalmology | 912 Nw 139th Street Pkwy, Edmond, OK 73013-9525 | 2006-03-03 |
| Find all providers in EDMOND | ||||
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| 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.