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General NPI Number Information
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NPI Number | 1861646937
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Entity Type | Individual
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Provider Name | JORDAN FREDERICK KEITH O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2008
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 3606 N 156TH ST
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City | OMAHA
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State | NE
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Zip | 68116-2158
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Country | US
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Telephone | 402-205-0754
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Fax |
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Provider Business Mailing Address
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Address Line | 3606 N 156TH ST STE 105
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City | OMAHA
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State | NE
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Zip | 68116-2163
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Country | US
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Telephone | 402-205-0754
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3153
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1589
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 116516
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License Number State | IA
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