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DR. SALLY BETH JACKULA OD
NPI 1902804149
Optometrist in Saint Cloud, MN

Active since July 12, 2005PECOS EnrolledAccepts Medicare Assignment
3112 SOUTHWAY DR, SAINT CLOUD, MN 56301(320) 257-4747(320) 262-7118 Get Directions Write a Review

NPPES record last updated: March 16, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Sally Beth Jackula Od NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SALLY BETH JACKULA OD (NPI 1902804149) is an individual optometrist in Saint Cloud, Minnesota, licensed in Minnesota (2895) and active in the NPI registry since July 2005. She is enrolled in Medicare PECOS and is a graduate of Pacific University - College Of Optometry (2002).

NPPES Registry Identity

NPI1902804149
Entity TypeIndividualFemale
Primary Taxonomy152W00000X
Provider Legal NameDR. SALLY BETH JACKULACredential: OD
Location Address3112 SOUTHWAY DRSaint Cloud, MN 56301-9589
Mailing Address3112 Southway DrSaint Cloud, MN 56301-9589 · (320) 257-4747 · Fax (320) 262-7118
Phone(320) 257-4747
Fax(320) 262-7118
Sole ProprietorYes
Medical School CMSPacific University - College Of OptometryGraduated 2002
Enumeration DateJuly 12, 2005
Last NPPES UpdateMarch 16, 2021
NPPES CertifiedMarch 16, 2021
✔ NPI 1902804149 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
License✔ Licensed in MN · 2895
Definition
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
3112 SOUTHWAY DR, Saint Cloud, MN 56301
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Other Identifiers 7

Medicaid126382000MN
Other207837MN · 207837
OtherHP37041MN · Hp
Other964141032721MN · P-1
Other125T6JAMN · Bcbs
Other141351MN · Ucare
Other22-01872MN · Medica

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Sally Beth Jackula Od is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3476569112
PECOS Enrollment IDI20060303000518
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 56301 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$127.61 typical visit price
range $56.00 – $168.28
Typical copayment $31.90 (range $14.00 – $42.07)
Most-billed visit code 99204
Established Patient
$69.74 typical visit price
range $18.32 – $138.04
Typical copayment $17.43 (range $4.58 – $34.51)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sally Jackula's NPI number?

The NPI number for Sally Jackula is 1902804149. It was assigned to this individual provider in the NPPES registry on July 12, 2005.

Where is Sally Jackula located?

Sally Jackula practices at 3112 Southway Dr, Saint Cloud, MN 56301. The listed phone number is (320) 257-4747.

What is Sally Jackula's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Sally Jackula enrolled in Medicare?

Yes. Sally Jackula is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Sally Jackula accept?

Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas, BlueCross BlueShield of Tennessee and HealthPartners and 2 other insurers list Sally Jackula as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Sally Jackula was last updated on March 16, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.