Individual
DR. ROBERT JACK JACKULA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4118 W DIVISION ST, SAINT CLOUD, MN 56301-3706
(320) 252-2021
(320) 252-7416
Mailing address
4118 W DIVISION ST, SAINT CLOUD, MN 56301-3706
(320) 252-2021
(320) 252-7416
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1574
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04563JA
BCBS
MN
01
—
111564
UCARE
MN
01
—
22-11984
MEDICA
MN
01
—
30610
COLE
MN
01
—
964141021424
P-1
MN
01
—
HP25479
HP
MN
Enumeration date
07/12/2005
Last updated
07/08/2007
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