JERREYLL TRAVIS JACKSON MD NPI 1629009576

NPI Information

  • NPI: 1629009576
  • Provider Name: JERREYLL TRAVIS JACKSON, MD
  • Classification: Ophthalmology - 207W00000X
  • Entity Type: Individual
  • Address: 4604 31ST AVE
    LONG ISLAND CITY, NY
    ZIP 11103
  • Phone: (212) 889-1171

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NPI Details

Jerreyll Travis Jackson, MD is an ophthalmology in Long Island City, NY. The provider is an ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. Jerreyll Travis Jackson, MD NPI is 1629009576. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4604 31ST AVE
LONG ISLAND CITY, NY
ZIP 11103-842
Phone: (212) 889-1171

The enumeration date for this NPI number is 7/6/2006 and was last updated on 12/8/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207W00000XOphthalmology25MA07982400NEW JERSEYNo
2207W00000XOphthalmology043661CONNECTICUTNo
3207W00000XOphthalmology237264NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10168092MEDICAIDNEW JERSEY
2095704CX9MEDICARE PINNEW JERSEY
3H37399MEDICARE UPINNEW YORK
402884251MEDICAIDNEW YORK
52751471MEDICAIDNEW YORK
6095704T64MEDICARE PINNEW JERSEY
7521A51MEDICARE PINNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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