Provider Demographics
NPI:1558337337
Name:JORDAN, HOWARD D (OD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:D
Last Name:JORDAN
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 1:1960 BETHEL RD
Mailing Address - Street 2:STE 150
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-1815
Mailing Address - Country:US
Mailing Address - Phone:614-459-4093
Mailing Address - Fax:614-459-4051
Practice Address - Street 1:1960 BETHEL RD
Practice Address - Street 2:SUITE 150
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-1814
Practice Address - Country:US
Practice Address - Phone:614-459-4093
Practice Address - Fax:614-459-4051
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3245/T929152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0401934Medicaid
OH9263631Medicare ID - Type Unspecified
OH0402760001Medicare NSC
OH0401934Medicaid