Provider Demographics
NPI:1679858724
Name:JANGULA, JORDAN
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:JANGULA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-5553
Mailing Address - Country:US
Mailing Address - Phone:701-252-5000
Mailing Address - Fax:701-282-8414
Practice Address - Street 1:210 10TH ST SE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-5553
Practice Address - Country:US
Practice Address - Phone:701-252-5000
Practice Address - Fax:701-952-5005
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND719152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist