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General NPI Number Information
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NPI Number | 1376929067
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Entity Type | Individual
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Provider Name | JORDAN CONLEY O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2015
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 12504 US ROUTE 60
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City | ASHLAND
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State | KY
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Zip | 41102-9687
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Country | US
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Telephone | 606-929-9432
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Fax | 606-929-9622
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Provider Business Mailing Address
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Address Line | 451 RIVER HILL DR
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City | ASHLAND
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State | KY
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Zip | 41101-7387
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Country | US
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Telephone | 606-929-9432
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Fax | 606-929-9622
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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 | 1982DT
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License Number State | KY
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