Provider Demographics
NPI:1093803660
Name:E L JORDAN JR DO PC
Entity Type:Organization
Organization Name:E L JORDAN JR DO PC
Other - Org Name:JORDAN EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:417-781-0044
Mailing Address - Street 1:2630 CUNNINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1542
Mailing Address - Country:US
Mailing Address - Phone:417-781-0044
Mailing Address - Fax:417-781-6331
Practice Address - Street 1:2630 CUNNINGHAM AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1542
Practice Address - Country:US
Practice Address - Phone:417-781-0044
Practice Address - Fax:417-781-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODG3737OtherRAILROAD MEDICARE
MO106677OtherBLUE CROSS BLUE SHIELD
KSDG3767OtherRAILROAD MEDICARE
KS100229750CMedicaid
OK200100060AMedicaid
MO505484402Medicaid
KS059024OtherBLUE CROSS BLUE SHIELD
KS100229750BMedicaid
MO100229750DMedicaid
OK200100060AMedicaid
MO505484402Medicaid