Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
RUSSELL B JACKSON, OD
ActiveRUSSELL B JACKSON, OD is a Optometrist healthcare provider located in FILLMORE, Utah. NPI 1922008663 is currently active in the NPPES registry. Verify at CMS.
Optometrist · FILLMORE, UT
Registration Details
- NPI Number
- 1922008663
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jul 22, 2005 (21.063664171894 yrs)
- Last Updated
- Dec 5, 2007
- License
-
375344-9934 (UT)
Practice Information
- Address
-
210 S 100 EFILLMORE, UT, 846312500Browse UT providers · Browse ZIP 84631
- Phone
- 4357436572
- Fax
- 4357435558
- Primary Specialty
-
Optometrist
152W00000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.