Healthcare Provider Details

I. General information

NPI: 1013843432
Provider Name (Legal Business Name): JORDAN KATZ OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 EAGLES LANDING PKWY
STOCKBRIDGE GA
30281-9081
US

IV. Provider business mailing address

759 BEDFORD OAKS DR
MARIETTA GA
30068-4403
US

V. Phone/Fax

Practice location:
  • Phone: 770-474-1237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003753
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: