Provider Demographics
NPI:1992110274
Name:JACKSON, CHRISTINE FARSON (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:FARSON
Last Name:JACKSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96160-0065
Mailing Address - Country:US
Mailing Address - Phone:978-502-2341
Mailing Address - Fax:
Practice Address - Street 1:10038 MEADOW WAY UNIT A
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4974
Practice Address - Country:US
Practice Address - Phone:530-587-1086
Practice Address - Fax:530-582-1929
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14996152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist