Jacks, Daniel Leroy
Jacks, Daniel Leroy is an sole proprietor health care provider with primary practice located at 7903 W Grandridge Blvd Ste 3 , Kennewick WA 99336-7827. He recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Corneal and Contact Management. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Jacks, Daniel Leroy can be contacted via phone (509) 783-0667.Contact Information
Primary practice address
7903 W Grandridge Blvd Ste 3
Kennewick WA 99336-7827
Phone: (509) 783-0667
Fax: (509) 735-7981
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 1091 | Washington |
| Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | 1091 | Washington |
Profile Details
| NPI number | 1427116888 |
|---|---|
| LBN Legal business name | Jacks, Daniel Leroy |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 5th, 2006 |
| Last updated | Aug 20th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1427116888 | NPPES |
| Washington | MEDICAID | 2040707 |
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