Healthcare Provider Details

I. General information

NPI: 1194755249
Provider Name (Legal Business Name): JACE HUNTER PICKEN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 2ND AVE NE STE 102
JAMESTOWN ND
58401-3373
US

IV. Provider business mailing address

315 11TH ST N STE A
WAHPETON ND
58075-4101
US

V. Phone/Fax

Practice location:
  • Phone: 701-252-2020
  • Fax:
Mailing address:
  • Phone: 701-642-4090
  • Fax: 701-642-9424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number694
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: