Healthcare Provider Details

I. General information

NPI: 1922110766
Provider Name (Legal Business Name): WILLIAM J JORDAN JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MIFFLIN AVE
SCRANTON PA
18503
US

IV. Provider business mailing address

200 MIFFLIN AVE
SCRANTON PA
18503
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-3145
  • Fax: 570-344-1309
Mailing address:
  • Phone: 570-342-3145
  • Fax: 570-344-1309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOS010538L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier180039161
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MEDICARE
# 2
IdentifierJO860893
Identifier TypeOTHER
Identifier State
Identifier IssuerHIGH MARK BLUE SHIELD
# 3
Identifier506554
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA
# 4
Identifier001788530
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 5
Identifier73290
Identifier TypeOTHER
Identifier State
Identifier IssuerGEISINGER HEALTH PLAN
# 6
Identifier815340
Identifier TypeOTHER
Identifier State
Identifier IssuerFIRST PRIORITY HEALTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: