MEDICARE: DRS. JORDAN & BONDURANT PLLC

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

General Provider Information

NPI Number	:	1790954246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS. JORDAN & BONDURANT PLLC

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	:	PARTNER
Name	:	ROB B JORDAN
Credential	:	O.D.
Telephone Number	:	731-885-0541

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	06/01/2009

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