Individual
DR. DANIEL LEROY JACKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
7903 W GRANDRIDGE BLVD STE 3, KENNEWICK, WA 99336-7827
(509) 783-0667
(509) 735-7981
Mailing address
7903 W GRANDRIDGE BLVD STE 3, KENNEWICK, WA 99336-7827
(509) 783-0667
(509) 735-7981
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1091
WA
152WC0802X
Corneal and Contact Management Optometrist
1091
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2040707
—
WA
Enumeration date
12/05/2006
Last updated
08/20/2012
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