Physician Compare National (NPI:1255427068)

HEALTHCARE PROVIDER: TIM JORDAN 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	1255427068
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1850315615
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20060119000308
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JORDAN
	Individual professional last name
Provider First Name	TIMOTHY
	Individual professional first name
Provider Middle Name	W
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	OD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	NEW ENGLAND COLLEGE OF OPTOMETRY
	Individual professional's medical school
Graduation Year	1997
	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	35 FRESH RIVER RD
	Group Practice or individual's line 1 address
City	EPPING
	Group Practice or individual's city
State	NH
	Group Practice or individual's state
Zip Code	030422225
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6036795147
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y