MEDICARE: MR. JORDAN MICHAEL TOWNSEND

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	156FX1101X	Ophthalmic Assistant	266891	CO

General Provider Information

NPI Number	:	1316423106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JORDAN MICHAEL TOWNSEND

Provider Business Mailing Address
First Line	:	5485 WILSON RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3523
Country	:	US
Telephone Number	:	719-534-3419
Fax Number	:

Provider Business Practice Location Address
First Line	:	5485 WILSON RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3523
Country	:	US
Telephone Number	:	719-534-3419
Fax Number	:

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

Provider Enumeration Date	:	07/14/2018
Last Update Date	:	07/14/2018

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