Healthcare Provider Details

I. General information

NPI: 1942992755
Provider Name (Legal Business Name): JORDAN ALLEN CARRINGTON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 TECHNOLOGY DR
SOUTH CHARLESTON WV
25309-8571
US

IV. Provider business mailing address

700 TECHNOLOGY DR
SOUTH CHARLESTON WV
25309-8571
US

V. Phone/Fax

Practice location:
  • Phone: 304-746-5300
  • Fax: 304-746-3912
Mailing address:
  • Phone: 304-746-5300
  • Fax: 304-746-3912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2341DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: