Provider Demographics
NPI:1104848951
Name:JORDAN, CHRISTOPHER (OD)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:JORDAN
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 1:81 E GAY STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-3103
Mailing Address - Country:US
Mailing Address - Phone:614-224-2414
Mailing Address - Fax:614-224-5916
Practice Address - Street 1:636 W SCHROCK ROAD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8996
Practice Address - Country:US
Practice Address - Phone:614-890-3577
Practice Address - Fax:614-890-5915
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0934225Medicaid
OH0934225Medicaid
OHJO0746456Medicare ID - Type Unspecified