MEDICARE: DR. CASSANDRA LEIGH JORDAN O.D.

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	OPT002888	GA
2	152W00000X	Optometrist	OPT0003367	CO
3	152W00000X	Optometrist	1580	NE

General Provider Information

NPI Number	:	1972987485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASSANDRA LEIGH JORDAN O.D.

Provider Business Mailing Address
First Line	:	17838 BURKE ST STE 100
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68118-2256
Country	:	US
Telephone Number	:	402-558-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	17838 BURKE ST STE 100
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68118-2256
Country	:	US
Telephone Number	:	402-558-2211
Fax Number	:

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

Provider Enumeration Date	:	07/14/2015
Last Update Date	:	11/09/2022

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