Provider Demographics
NPI:1003360462
Name:ALEXANDER, JORDAN LEE ELLIS (OD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:LEE ELLIS
Last Name:ALEXANDER
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 1:470 TOWN CENTER PL
Mailing Address - Street 2:B125 LENSCRAFTERS
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7955
Mailing Address - Country:US
Mailing Address - Phone:803-865-3901
Mailing Address - Fax:
Practice Address - Street 1:470 TOWN CENTER PL
Practice Address - Street 2:B125 LENSCRAFTERS
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7955
Practice Address - Country:US
Practice Address - Phone:803-865-3901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1939152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist