Provider Demographics
NPI:1033497557
Name:HAGLER, JORDAN D (OD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:D
Last Name:HAGLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21023 ROAD D
Mailing Address - Street 2:
Mailing Address - City:ATWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:67730-3143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1005 S RANGE AVE
Practice Address - Street 2:STE 100
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-3537
Practice Address - Country:US
Practice Address - Phone:785-462-8231
Practice Address - Fax:785-462-2307
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1897152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200877170AMedicaid
KS200877170AMedicaid