Jordan, Douglas R
Jordan, Douglas R is an individual health care provider with primary practice located at 2943 Highway 62 W , Mountain Home AR 72653-6535. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Jordan, Douglas R can be contacted via phone (870) 424-4900.Contact Information
Primary practice address
2943 Highway 62 W
Mountain Home AR 72653-6535
Phone: (870) 424-4900
Fax: (870) 424-4979
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | T 03117 | Missouri |
| Eye and Vision Services Providers / Optometrist | 152W00000X | 4021 | Arkansas |
Profile Details
| NPI number | 1790760197 |
|---|---|
| LBN Legal business name | Jordan, Douglas R |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 8th, 2005 |
| Last updated | Aug 19th, 2021 - about 3 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 | 1790760197 | NPPES |
| Missouri | Other | 108285 | BLUE CROSS BLUE SHIELD |
| Missouri | MEDICAID | 244744722 | BLUE CROSS BLUE SHIELD |
| Missouri | MEDICAID | 316781608 | BLUE CROSS BLUE SHIELD |
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