MEDICARE: DR. JORDAN JAMISON PIERCE 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	7417TG	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	TXB102635	OTHER	TX	MEDICARE PART B PROVIDER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992937262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN JAMISON PIERCE O.D.

Provider Business Mailing Address
First Line	:	5310 N TARRANT PKWY
Second Line	:	STE 128
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5386
Country	:	US
Telephone Number	:	817-514-2114
Fax Number	:	817-514-2150

Provider Business Practice Location Address
First Line	:	5310 N TARRANT PKWY
Second Line	:	STE 128
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5386
Country	:	US
Telephone Number	:	817-514-2114
Fax Number	:	817-514-2150

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

Provider Enumeration Date	:	08/19/2009
Last Update Date	:	01/10/2011

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