Provider Demographics
NPI:1710331160
Name:JOURDAN, REBECCA (OD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:JOURDAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:CLAIRE
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4605 S COOPER ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5827
Mailing Address - Country:US
Mailing Address - Phone:218-831-5441
Mailing Address - Fax:
Practice Address - Street 1:4605 S COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5827
Practice Address - Country:US
Practice Address - Phone:817-557-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60764823152W00000X
TX10079T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist