Organization
IRIS VISION CARE, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SALLY BETH JACKULA OD (OWNER)
(320) 281-4787
Entity
Organization
Contact information
Practice address
1301 33RD ST S, SUITE 104, SAINT CLOUD, MN 56301-9668
(320) 281-4787
Mailing address
1301 33RD ST S, SUITE 104, SAINT CLOUD, MN 56301-9668
(320) 281-4787
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
2757
MN
Other
Enumeration date
05/18/2009
Last updated
05/18/2009
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