Jackula, Sally Beth

Jackula, Sally Beth is an sole proprietor health care provider with primary practice located at 3112 Southway Dr , Saint Cloud MN 56301-9589. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Jackula, Sally Beth can be contacted via phone (320) 257-4747.

Contact Information

Primary practice address
3112 Southway Dr Saint Cloud MN 56301-9589
Phone: (320) 257-4747
Fax: (320) 262-7118
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 2895 Minnesota

Profile Details

NPI number 1902804149
LBN Legal business name Jackula, Sally Beth
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 12th, 2005
Last updated Mar 16th, 2021 - about 4 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902804149 NPPES
Minnesota Other 207837 207837
Minnesota Other 22-01872 207837
Minnesota Other 125T6JA 207837
Minnesota MEDICAID 126382000 207837
Minnesota Other 141351 207837
Minnesota Other 964141032721 207837
Minnesota Other HP37041 207837

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