Provider Demographics
NPI:1275616930
Name:JORDAN, ABBIE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:ABBIE
Middle Name:MARIE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ABBIE
Other - Middle Name:MARIE
Other - Last Name:STENSLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:20715 NW PAINTED MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-1693
Mailing Address - Country:US
Mailing Address - Phone:503-466-1115
Mailing Address - Fax:
Practice Address - Street 1:19500 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-5757
Practice Address - Country:US
Practice Address - Phone:503-799-7081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3110ATI152W00000X
WA3965152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist