Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1800X | Optician | 691-S | OH |
NPI | 1083042345 |
---|---|
Provider Name | Kristina Yvette Jackson |
First Address | Strongsville, OH 44136-6369 |
Second Address | Strongsville, OH 44136-6369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2013 |
Last Update Date | 24/10/2013 |