Provider Demographics
NPI:1174019962
Name:CHILLA, JORDAN M (OD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:M
Last Name:CHILLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:M
Other - Last Name:HEIDELBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:402 BAYARD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1862
Mailing Address - Country:US
Mailing Address - Phone:484-770-8132
Mailing Address - Fax:
Practice Address - Street 1:402 BAYARD RD STE 200
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-1862
Practice Address - Country:US
Practice Address - Phone:484-770-8132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003411152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist