Provider Demographics
NPI:1205389566
Name:BARNWELL, JORDAN (OD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:BARNWELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 S HARVARD AVE
Mailing Address - Street 2:STE 135
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2925
Mailing Address - Country:US
Mailing Address - Phone:918-745-9662
Mailing Address - Fax:
Practice Address - Street 1:4520 S HARVARD AVE
Practice Address - Street 2:STE 135
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2925
Practice Address - Country:US
Practice Address - Phone:918-745-9662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2877152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist