MEDICARE: DR. ROBERT B JORDAN 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	ODT1210	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0151506	OTHER	TN	BLUECROSS BLUESHIELD TN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	940073	OTHER	TN	EYEMED
4	13835	OTHER	TN	SPECTRA
5	0468680001	OTHER	KY	NATIONAL GOVERNMENT DEMAC

General Provider Information

NPI Number	:	1265501126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT B JORDAN OD

Provider Business Mailing Address
First Line	:	622 E REELFOOT AVE
Second Line	:
City	:	UNION CITY
State	:	TN
Zip	:	38261-5739
Country	:	US
Telephone Number	:	731-885-0541
Fax Number	:	731-885-0588

Provider Business Practice Location Address
First Line	:	622 E REELFOOT AVE
Second Line	:
City	:	UNION CITY
State	:	TN
Zip	:	38261-5739
Country	:	US
Telephone Number	:	731-885-0541
Fax Number	:	731-885-0588

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	06/01/2009

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