Healthcare Provider Details

I. General information

NPI: 1932025764
Provider Name (Legal Business Name): JORDAN ELISABETH FOX OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 W APACHE TRL
APACHE JUNCTION AZ
85120-3425
US

IV. Provider business mailing address

9031 S MINEROS DR
APACHE JUNCTION AZ
85120-7714
US

V. Phone/Fax

Practice location:
  • Phone: 480-824-7360
  • Fax:
Mailing address:
  • Phone: 816-518-6156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002960
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: