Jackula, Robert Jack

Jackula, Robert Jack is an individual health care provider with primary practice located at 4118 W Division St , Saint Cloud MN 56301-3706. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Jackula, Robert Jack can be contacted via phone (320) 252-2021.

Contact Information

Primary practice address
4118 W Division St Saint Cloud MN 56301-3706
Phone: (320) 252-2021
Fax: (320) 252-7416
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 1574 Minnesota

Profile Details

NPI number 1528066776
LBN Legal business name Jackula, Robert Jack
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 12th, 2005
Last updated Jul 8th, 2007 - about 17 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.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1528066776 NPPES
Minnesota Other 964141021424 P-1
Minnesota Other 04563JA P-1
Minnesota Other 30610 P-1
Minnesota Other 22-11984 P-1
Minnesota Other 111564 P-1
Minnesota Other HP25479 P-1

Popular Providers