Provider Demographics
NPI:1013584549
Name:UKENA, JORDAN L (OD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:L
Last Name:UKENA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:111 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-1754
Mailing Address - Country:US
Mailing Address - Phone:515-964-7355
Mailing Address - Fax:515-964-8413
Practice Address - Street 1:5501 NW 8TH STREET
Practice Address - Street 2:SUITE 500
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131
Practice Address - Country:US
Practice Address - Phone:515-270-0494
Practice Address - Fax:515-270-6463
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA108457152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA108457OtherSTATE LICENSE