Healthcare Provider Details

I. General information

NPI: 1013082494
Provider Name (Legal Business Name): JORDAN MILES KAY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 CLEVELAND AVE SUITE #113
FORT MYERS FL
33901-9046
US

IV. Provider business mailing address

5621 COACH HOUSE CIR SUITE B
BOCA RATON FL
33486-8686
US

V. Phone/Fax

Practice location:
  • Phone: 239-939-5393
  • Fax: 239-275-3780
Mailing address:
  • Phone: 561-362-9849
  • Fax: 239-275-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1757
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: