MEDICARE: MICHAEL ARTHUR JORDAN OD

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	152W00000X	Optometrist	S795TA318	AL

General Provider Information

NPI Number	:	1588755862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ARTHUR JORDAN OD

Provider Business Mailing Address
First Line	:	3925 PRIVATE ROAD 304
Second Line	:
City	:	SEMMES
State	:	AL
Zip	:	36575-6043
Country	:	US
Telephone Number	:	251-649-6848
Fax Number	:

Provider Business Practice Location Address
First Line	:	3063 DAUPHIN ST
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36606-4040
Country	:	US
Telephone Number	:	251-476-2743
Fax Number	:

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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