Physician Compare National (NPI:1104206325)

HEALTHCARE PROVIDER: JORDAN PATRICK DAU O.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1104206325
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8022321090
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150720002588
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DAU
	Individual professional last name
Provider First Name	JORDAN
	Individual professional first name
Provider Middle Name	PATRICK
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	SOUTHERN COLLEGE OF OPTOMETRY
	Individual professional's medical school
Graduation Year	2015
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	132 EVEREST LN
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 5
	Group Practice or individual's line 2 address
City	SAINT JOHNS
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	322594090
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y