Provider Demographics
NPI:1578239927
Name:ROGALINER, JORDAN ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:ELIZABETH
Last Name:ROGALINER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:ELIZABETH
Other - Last Name:BOROWIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6650 SUMMERLYN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144
Mailing Address - Country:US
Mailing Address - Phone:734-854-3937
Mailing Address - Fax:
Practice Address - Street 1:6650 SUMMERLYN LAKES DR
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-4814
Practice Address - Country:US
Practice Address - Phone:734-854-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005566152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist