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General NPI Number Information
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NPI Number | 1790668614
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Entity Type | Organization
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Legal Business Name | JESSICA JORDAN OD LLC
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 08/03/2025
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Provider Practice Location Address
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Address Line | 5131 S RIDGEWOOD AVE STE A
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City | PORT ORANGE
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State | FL
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Zip | 32127-5168
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Country | US
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Telephone | 386-222-2991
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Fax |
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Provider Business Mailing Address
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Address Line | 1648 TAYLOR RD STE 413
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City | PORT ORANGE
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State | FL
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Zip | 32128-6753
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JESSICA MAYA JORDAN
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Credential | OD
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Telephone | 808-286-5529
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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 |
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License Number State |
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