Individual
DR. DANIEL LEROY JACKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
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
Update your record
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