MEDICARE: DR. JAMES H JORDAN JR. O.D.

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	2050	CO

General Provider Information

NPI Number	:	1891788832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES H JORDAN JR. O.D.

Provider Business Mailing Address
First Line	:	12191 W 64TH AVE
Second Line	:	SUITE 108
City	:	ARVADA
State	:	CO
Zip	:	80004-4033
Country	:	US
Telephone Number	:	303-996-3550
Fax Number	:

Provider Business Practice Location Address
First Line	:	12191W 64TH AVE 108
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80004-4030
Country	:	US
Telephone Number	:	303-996-3550
Fax Number	:

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	11/14/2015

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