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General NPI Number Information
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NPI Number | 1104848951
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Entity Type | Individual
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Provider Name | CHRISTOPHER JORDAN OD
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Gender | Male
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 636 W SCHROCK ROAD
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City | WESTERVILLE
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State | OH
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Zip | 43081-8996
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Country | US
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Telephone | 614-890-3577
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Fax | 614-890-5915
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Provider Business Mailing Address
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Address Line | 81 E GAY STREET
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City | COLUMBUS
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State | OH
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Zip | 43215-3103
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Country | US
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Telephone | 614-224-2414
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Fax | 614-224-5916
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4464
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License Number State | OH
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