Provider Demographics
NPI:1003254590
Name:JORDAN, LAUREN (OD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 BUNKER LAKE BLVD NW
Mailing Address - Street 2:STE 101
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-3669
Mailing Address - Country:US
Mailing Address - Phone:651-482-1959
Mailing Address - Fax:
Practice Address - Street 1:200 VILLAGE CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:NORTH OAKS
Practice Address - State:MN
Practice Address - Zip Code:55127-7088
Practice Address - Country:US
Practice Address - Phone:651-482-1959
Practice Address - Fax:651-482-1850
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3405-35152W00000X
MN3461152W00000X
IL046010664152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist