Provider Demographics
NPI:1215089776
Name:JACKSON EYE ASSOCIATES PLLC
Entity type:Organization
Organization Name:JACKSON EYE ASSOCIATES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-352-0025
Mailing Address - Street 1:1190 N STATE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2413
Mailing Address - Country:US
Mailing Address - Phone:601-352-0025
Mailing Address - Fax:601-352-0037
Practice Address - Street 1:401 BAPTIST DR
Practice Address - Street 2:STE 408
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-2013
Practice Address - Country:US
Practice Address - Phone:601-853-2020
Practice Address - Fax:601-853-2728
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON EYE ASSOCIATES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-17
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4164332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSCH0425OtherMEDICARE RR
MS=========COtherBLUE CROSS
MSC02972Medicare PIN
MSCH0425OtherMEDICARE RR