Ballantyne, Jordan Brett
Ballantyne, Jordan Brett is an individual health care provider with primary practice located at 302 W 3Rd St , La Junta CO 81050-1430. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Ballantyne, Jordan Brett can be contacted via phone (719) 383-0134.Contact Information
Primary practice address
302 W 3Rd St
La Junta CO 81050-1430
Phone: (719) 383-0134
Fax: (719) 404-1825
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2799 | Colorado |
Profile Details
| NPI number | 1326352212 |
|---|---|
| LBN Legal business name | Ballantyne, Jordan Brett |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 3rd, 2010 |
| Last updated | Oct 10th, 2016 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1326352212 | NPPES |
| Colorado | MEDICAID | 93920288 | |
| Colorado | Other | COA105677 | |
| Colorado | Other | 12141883 |
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