Provider Demographics
NPI:1770255267
Name:RANCIC, JAKE DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:JAKE
Middle Name:DAVID
Last Name:RANCIC
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:144 TYLER RD N STE B
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-1889
Mailing Address - Country:US
Mailing Address - Phone:651-388-3838
Mailing Address - Fax:651-388-6838
Practice Address - Street 1:144 TYLER RD N STE B
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-1889
Practice Address - Country:US
Practice Address - Phone:651-388-3838
Practice Address - Fax:651-388-6838
Is Sole Proprietor?:No
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3751152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNMN3751OtherSTATE LICENSE