Active NPI
Robert Jack Jackula, OD
- Optometrist
- Saint Cloud, MN
National Provider Identifier
1528066776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1574
- Practice address
- 4118 W Division St
Saint Cloud, MN 56301-3706 - Phone
- (320) 252-2021
- Fax
- (320) 252-7416
- NPI assigned
- Jul 12, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1574 | MN | Primary |
Addresses
Primary practice location
4118 W Division St
Saint Cloud, MN 56301-3706
Mailing address
4118 W Division St
Saint Cloud, MN 56301-3706
Phone (320) 252-2021
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 964141021424 | Other | MN | P-1 |
| 04563JA | Other | MN | BCBS |
| 30610 | Other | MN | COLE |
| 22-11984 | Other | MN | MEDICA |
| 111564 | Other | MN | UCARE |
| HP25479 | Other | MN | HP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1528066776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4118 W DIVISION ST",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563013706",
"telephone_number": "320-252-2021",
"fax_number": "320-252-7416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4118 W DIVISION ST",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563013706",
"telephone_number": "320-252-2021",
"fax_number": "320-252-7416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKULA",
"first_name": "ROBERT",
"middle_name": "JACK",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-12",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "1574",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "P-1",
"identifier": "964141021424",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "04563JA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COLE",
"identifier": "30610",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "22-11984",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "111564",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HP",
"identifier": "HP25479",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.