| Doctor Name: | KRISTINA YVETTE JACKSON |
| NPI Number: | 1083042345 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 691-S |
| Business Practice Address: | 16770 Pheasant Trail Pl Strongsville, OH - 441366369 |
| Business Phone Number: | 4403052822 |
| Business Fax Number: | |
| Mailing Address: | 16770 Pheasant Trail Pl, STRONGSVILLE |
| State: | OH |
| Postal Code: | 441366369 |
| Phone Number: | 4403052822 |
| Fax Number: | |
| NPI Enumeration Date: | 10/24/2013 |
| NPI Last Update Date: | 10/24/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | 691-S |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |