MEDICARE: STEVEN JORDAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	DO3073	FL

General Provider Information

NPI Number	:	1538438619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN JORDAN

Provider Business Mailing Address
First Line	:	235 COMMERCIAL BLVD
Second Line	:
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-4452
Country	:	US
Telephone Number	:	954-491-5818
Fax Number	:	954-491-5819

Provider Business Practice Location Address
First Line	:	235 COMMERCIAL BLVD
Second Line	:
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-4452
Country	:	US
Telephone Number	:	954-491-5818
Fax Number	:	954-491-5819

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2011
Last Update Date	:	12/20/2011

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Directions to “ STEVEN JORDAN ” Practice Location

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