Provider Demographics
NPI:1790897536
Name:JORDAN, ARTHUR J SR (OD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:J
Last Name:JORDAN
Suffix:SR
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 1:200 MIFFLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503
Mailing Address - Country:US
Mailing Address - Phone:570-342-3145
Mailing Address - Fax:570-344-1309
Practice Address - Street 1:200 MIFFLIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503
Practice Address - Country:US
Practice Address - Phone:570-342-3145
Practice Address - Fax:570-344-1309
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001152152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
506554OtherAETNA
PA00116872Medicaid
410024724OtherRAILROAD MEDICARE
072739OtherFIRST PRIORITY HEALTH
JO054606OtherHIGH MARK BLUE SHIELD
13838OtherGEISINGER HEALTH PLAN
JO054606OtherHIGH MARK BLUE SHIELD
072739OtherFIRST PRIORITY HEALTH