Russell B Jackson Od is a
Optometrist based in Fillmore, Utah. Russell B Jackson Od is licensed to practice in Utah (license number 375344-9934) and their current practice location is
210 S 100 W, Fillmore, Utah. It can be reached at their office (for appointments etc.) via phone at
(435) 743-6572.
NPI number for Russell B Jackson Od is 1912181967 and their current mailing address is Po Box 73, Fillmore, Utah. Russell B Jackson Od
does not participate in medicare program and thus does not accept medicare assignments. The facility's NPI Number is 1912181967.
Healthcare Provider's Profile
| Full Name | Russell B Jackson Od |
|---|
| Type | Facility |
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| Speciality | Optometrist |
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| Location | 210 S 100 W, Fillmore, Utah |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1912181967
- Provider Enumeration Date: 12/27/2007
- Last Update Date: 12/27/2007
Medical Identifiers
Medical identifiers for Russell B Jackson Od such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1912181967 | NPI | - | NPPES |
| 528882505001 | Medicaid | UT | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 152W00000X | Optometrist | 375344-9934 (Utah) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Russell B Jackson Od is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Russell B Jackson Od
Po Box 73,
Fillmore, UT 84631-0073
Ph: (435) 743-6572 | Russell B Jackson Od
210 S 100 W,
Fillmore, UT 84631
Ph: (435) 743-6572 |
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