Dr. Sally Beth Jackula, OD
Optometrist in Saint Cloud, MN. Individual provider (NPI-1).
NPI number1902804149
StatusActive
Last updated in NPPESMar 16, 2021
Details
- NPI
- 1902804149
- Entity type
- Individual (NPI-1)
- Name
- Dr. Sally Beth Jackula
- Credential
- OD
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jul 12, 2005
- Certification date
- Mar 16, 2021
- Last updated
- Mar 16, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - OPTOMETRY
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 2895 | MN | Yes |
Practice location
3112 Southway DrSaint Cloud, MN 56301-9589
Phone 320-257-4747 · Fax 320-262-7118
Mailing address
3112 Southway DrSaint Cloud, MN 56301-9589
Phone 320-257-4747 · Fax 320-262-7118
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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