Provider Demographics
NPI:1518525856
Name:O'DELL, JORDAN ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:ELIZABETH
Last Name:O'DELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:ELIZABETH
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:921 NE 13TH STREET OKC VA HCS
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104
Mailing Address - Country:US
Mailing Address - Phone:405-456-3909
Mailing Address - Fax:405-456-5144
Practice Address - Street 1:921 NE 13TH STREET OKC VA HCS
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-456-3909
Practice Address - Fax:405-456-5144
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-02
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35024207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology