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General NPI Number Information
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NPI Number | 1437966827
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Entity Type | Individual
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Provider Name | ALEXANDER JORDAN
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Gender | Male
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Dates
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Enumeration Date | 12/18/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 1505 COUNTY ROAD 220
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-7926
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Country | US
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Telephone | 904-215-4994
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Fax | 904-264-2871
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Provider Business Mailing Address
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Address Line | 752 GINGER MILL DR
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City | JACKSONVILLE
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State | FL
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Zip | 32259-6261
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Country | US
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Telephone | 904-613-0246
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Fax |
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO8000
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License Number State | FL
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