Healthcare Provider Details

I. General information

NPI: 1841122504
Provider Name (Legal Business Name): MARY ELIZABETH JORDAN-JOHNSON ABO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 LINCOLN HWY E
LANCASTER PA
17602-3329
US

IV. Provider business mailing address

204 CLIFTON AVE
READING PA
19611-1818
US

V. Phone/Fax

Practice location:
  • Phone: 717-390-8784
  • Fax: 717-390-9085
Mailing address:
  • Phone: 717-390-8784
  • Fax: 717-390-9085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number261500
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: