| Iris Vision Care, Llc. | |
|
1301 33rd St S Suite 104 Saint Cloud MN 56301-9668 | |
| (320) 281-4787 | |
| Not Available |
| Full Name | Iris Vision Care, Llc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1301 33rd St S, Saint Cloud, Minnesota |
| Authorized Official Name and Position | Sally Beth Jackula (OWNER) |
| Authorized Official Contact | 3202814787 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Iris Vision Care, Llc. 1301 33rd St S Suite 104 Saint Cloud MN 56301-9668 Ph: (320) 281-4787 | Iris Vision Care, Llc. 1301 33rd St S Suite 104 Saint Cloud MN 56301-9668 Ph: (320) 281-4787 |
| NPI Number | 1679708887 |
|---|---|
| Provider Enumeration Date | 05/18/2009 |
| Last Update Date | 05/18/2009 |
| Medicare PECOS PAC ID | 2860538337 |
|---|---|
| Medicare Enrollment ID | O20091014000282 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679708887 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 2757 (Minnesota) | Primary |
| Provider Name | Sally B Jackula |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1902804149 PECOS PAC ID: 3476569112 Enrollment ID: I20060303000518 |
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