Provider Demographics
NPI:1700036829
Name:JORDAN, ROBERT PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
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 1:1901 VILLAGE RD W
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-2516
Mailing Address - Country:US
Mailing Address - Phone:781-769-9364
Mailing Address - Fax:
Practice Address - Street 1:1009 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-3619
Practice Address - Country:US
Practice Address - Phone:508-699-5173
Practice Address - Fax:508-699-4892
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4716152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist