Provider Demographics
NPI:1003820051
Name:JORDAN, LAUREL A (OD)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:A
Last Name:JORDAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LAUREL
Other - Middle Name:A
Other - Last Name:MEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:301 N. WASHINGTON HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005
Mailing Address - Country:US
Mailing Address - Phone:540-287-3290
Mailing Address - Fax:804-798-3617
Practice Address - Street 1:301 N WASHINGTON HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-1650
Practice Address - Country:US
Practice Address - Phone:804-798-3306
Practice Address - Fax:804-798-3617
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001037152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV00857Medicare UPIN