MEDICARE: DR. SALLY BETH JACKULA OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2895	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	207837	OTHER	MN	207837
2	22-01872	OTHER	MN	MEDICA
3	125T6JA	OTHER	MN	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	141351	OTHER	MN	UCARE
6	964141032721	OTHER	MN	P-1
7	HP37041	OTHER	MN	HP

General Provider Information

NPI Number	:	1902804149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALLY BETH JACKULA OD

Provider Business Mailing Address
First Line	:	3112 SOUTHWAY DR
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-9589
Country	:	US
Telephone Number	:	320-257-4747
Fax Number	:	320-262-7118

Provider Business Practice Location Address
First Line	:	3112 SOUTHWAY DR
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-9589
Country	:	US
Telephone Number	:	320-257-4747
Fax Number	:	320-262-7118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	03/16/2021

Similar Medicare Providers

1104785484 — REBECCA BROSTE-GARNER
Practice Location Address:

3721 23RD ST S
SAINT CLOUD, MN
56301-6198

Practice Phone: 605-271-2690
Practice Fax: 605-271-3956

1952176141 — FARHIYA IMAN
Practice Location Address:

3845 BEAR RIDGE AVE S
SAINT CLOUD, MN
56301-6244

Practice Phone: 320-260-6718
Practice Fax:

1578378428 — GUARDIAN HOME SUPPORT LLC
Practice Location Address:

145 25TH AVE S STE 215
SAINT CLOUD, MN
56301-3900

Practice Phone: 651-418-9040
Practice Fax:

1881543882 — JESSICA JACOBS
Practice Location Address:

226 PARK AVE S STE 200
SAINT CLOUD, MN
56301-3713

Practice Phone: 320-301-0039
Practice Fax:

1194516005 — SUSHAN CHAUDHARY
Practice Location Address:

3721 23RD ST S
SAINT CLOUD, MN
56301-6198

Practice Phone: 605-271-2690
Practice Fax: 605-271-3956

1487341624 — SPEAKWISE SOLUTIONS LLC
Practice Location Address:

3333 W DIVISION ST STE 200
SAINT CLOUD, MN
56301-4322

Practice Phone: 320-223-5102
Practice Fax:

Directions to “ DR. SALLY BETH JACKULA OD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.