Provider Demographics
NPI:1972655421
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:601-353-2020
Mailing Address - Street 1:1190 N STATE ST
Mailing Address - Street 2:STE 401
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2413
Mailing Address - Country:US
Mailing Address - Phone:601-353-2020
Mailing Address - Fax:601-714-5110
Practice Address - Street 1:401 BAPTIST DRIVE
Practice Address - Street 2:SUITE 408
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110
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:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4163207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03189030Medicaid
MS03189030Medicaid
MSCH0425Medicare ID - Type UnspecifiedMEDICARE RR GROUP