ALLEN THOMAS JACKSON (NPI# 1932151479) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932151479 |
| Entity Type | Individual |
| Full Name | ALLEN THOMAS JACKSON |
| Credential | MD |
| Practice Address |
1201 S Ridgewood Ave Daytona Beach FL 32114-6123 |
| Practice Telephone | 3864927718 |
| Practice Fax Number | 3864927720 |
| Mailing Telephone | 3864927718 |
| Mailing Fax Number | 3864927720 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2015-01-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207W00000X | Ophthalmology | ME80695 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 001628800 | 05 | |
| DEA | BJ9222376 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902866965 | Allen B Jackson | Internal Medicine | 2175 Ashley Phosphate Rd, Suite D, North Charleston, SC 29406-4181 | 2006-03-24 |
| 1902281645 | Allen Jackson | Home Health | General Delivery, Grand Rapids, MI 49501-9999 | 2015-07-23 |
| 1083683205 | Allen W. Jackson | Orthopaedic Surgery | 10330 Meridian Ave N, Suite 270, Seattle, WA 98133-9451 | 2006-03-17 |
| 1477544955 | Allen Charles Jackson | Emergency Medicine | 624 Hospital Dr, Mountain Home, AR 72653-2955 | 2005-11-02 |
| Street Address |
1201 S RIDGEWOOD AVE |
| City | DAYTONA BEACH |
| State | FL |
| Zip Code | 32114-6123 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376161380 | Evolution Health & Performance LLC | Physician Assistant | 244 S. Palmetto Ave, Daytona Beach, FL 32114 | 2020-07-07 |
| 1407480189 | Kierra Imani Kinsey | Behavior Technician | 1128-a Beville Rd, Daytona Beach, FL 32114 | 2020-03-02 |
| 1043776057 | Outreach Community Care Network Inc | Pharmacy | 240 N. Frederick Avenue, Daytona Beach, FL 32114 | 2019-02-14 |
| 1033681861 | Katherine Proppe | Specialist/Technologist | 1 Aerospace Blvd, Daytona Beach, FL 32114 | 2018-12-18 |
| 1841765047 | Anna L Smith | Nurse Practitioner | 339 Bill France Blvd Ste C, Daytona Beach, FL 32114 | 2018-10-04 |
| 1154806933 | Steve Anthony Lee | Family Medicine | 731 N. Clyde Morris Blvd, Daytona Beach, FL 32114 | 2018-09-27 |
| 1285116491 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1348 W International Speedway Blvd Ste 2, Daytona Beach, FL 32114 | 2018-09-04 |
| 1770085656 | Merina Lee | Occupational Therapist | 1159 Australia Ave., Daytona Beach, FL 32114 | 2018-03-06 |
| 1346752755 | Hand & Upper Extremity Surgery of Daytona Beach, LLC | Non-Pharmacy Dispensing Site | 1241 Ridgewood Ave, Daytona Beach, FL 32114 | 2017-10-26 |
| 1104347053 | Harry Herman Blanke IIi | Family Medicine | 201 N Clyde Morris Blvd, Suite 200, Halifax Health Family Medicine Residency Program, Daytona Beach, FL 32114 | 2017-06-30 |
| Find all providers in zip 32114 | ||||
| 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 |
|---|---|---|---|---|
| 1225307424 | Robert R. Young, M.d. P.a. | Ophthalmology | 163 E International Speedway Blvd, Daytona Beach, FL 32118-4648 | 2011-12-19 |
| 1194048488 | Nishita D Patel | Ophthalmology | 517 N Clyde Morris Blvd, Daytona Beach, FL 32114-2323 | 2010-03-01 |
| 1790863116 | Donald Michael Cardone | Ophthalmology | 517 N. Clyde Morris Blvd., Daytona Beach, FL 32114-2323 | 2006-11-02 |
| 1235168659 | Suzanne M. Demming | Ophthalmology | 529 Health Blvd, Daytona Beach, FL 32114-1493 | 2006-06-30 |
| 1225038441 | William J Dunn | Ophthalmology | 564 Health Blvd, Daytona Beach, FL 32114-1492 | 2005-07-29 |
| 1235136219 | Robert Runyan Young | Ophthalmology | 505 Health Blvd, Daytona Beach, FL 32114-1493 | 2005-07-05 |
| 1932514585 | Itza Marie Acevedo Ojeda | Ophthalmology | 505 Health Blvd, Daytona Beach, FL 32114 | 2014-06-23 |
| 1891130829 | William Jessup Carroll | Ophthalmology | 529 Health Blvd, Daytona Beach, FL 32114-1493 | 2013-05-03 |
| 1154631307 | Donald M. Cardone, M.d., P.a. | Ophthalmology | 517 N Clyde Morris Blvd, Daytona Beach, FL 32114-2323 | 2010-10-20 |
| 1245569508 | 3d Vision Eye Surgery Center Pa | Ophthalmology | 1893 N Clyde Morris Blvd, Suite 100, Daytona Beach, FL 32117-5535 | 2009-12-16 |
| Find all providers in DAYTONA BEACH | ||||
| City | DAYTONA BEACH |
| Zip Code | 32114 |
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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.