Individual
TRACY A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
424 W STATE HIGHWAY 5, WACONIA, MN 55387-1723
(952) 442-4461
(952) 442-1218
Mailing address
424 W STATE HIGHWAY 5, WACONIA, MN 55387-1723
(952) 442-4461
(952) 442-1218
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2905
MN
Other
Enumeration date
11/03/2006
Last updated
07/08/2007
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