MEDICARE: JESSICA JORDAN OD LLC

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

General Provider Information

NPI Number	:	1790668614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSICA JORDAN OD LLC

Provider Business Mailing Address
First Line	:	1648 TAYLOR RD STE 413
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-6753
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5131 S RIDGEWOOD AVE STE A
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-5168
Country	:	US
Telephone Number	:	386-222-2991
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. JESSICA MAYA JORDAN
Credential	:	OD
Telephone Number	:	808-286-5529

Provider Enumeration Date	:	07/29/2025
Last Update Date	:	08/03/2025

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Directions to “JESSICA JORDAN OD LLC ” Practice Location

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