Provider Demographics
NPI:1659668044
Name:JORDAN, EMILY SUZANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:SUZANNE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5002 GATTIS SCHOOL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-2028
Mailing Address - Country:US
Mailing Address - Phone:512-243-7858
Mailing Address - Fax:512-243-7835
Practice Address - Street 1:5002 GATTIS SCHOOL RD STE 100
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-2028
Practice Address - Country:US
Practice Address - Phone:512-243-7858
Practice Address - Fax:512-243-7835
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7756TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist