Provider Demographics
NPI:1699191155
Name:JORDAN, LINDA FISCHER
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:FISCHER
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15735 E BROADWAY AVE STE 3C2
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-8547
Mailing Address - Country:US
Mailing Address - Phone:509-922-0795
Mailing Address - Fax:509-924-4764
Practice Address - Street 1:15735 E BROADWAY AVE STE 3C2
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-8547
Practice Address - Country:US
Practice Address - Phone:509-922-0795
Practice Address - Fax:509-924-4764
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO 00000384156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician