Provider Demographics
NPI:1275100430
Name:WEBB, JORDAN D (OD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:D
Last Name:WEBB
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 1:1770 S 165 W
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-4908
Mailing Address - Country:US
Mailing Address - Phone:801-660-9284
Mailing Address - Fax:
Practice Address - Street 1:81 N 2000 W STE F1
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:UT
Practice Address - Zip Code:84015-8777
Practice Address - Country:US
Practice Address - Phone:801-516-4821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT123261529934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist