Provider Demographics
NPI:1790954246
Name:DRS. JORDAN & BONDURANT PLLC
Entity Type:Organization
Organization Name:DRS. JORDAN & BONDURANT PLLC
Other - Org Name:CHARLES DENABURG ROB B. JORDAN DRS. DENABURG & JORDAN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:B
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:731-885-0541
Mailing Address - Street 1:622 E REELFOOT AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5739
Mailing Address - Country:US
Mailing Address - Phone:731-885-0541
Mailing Address - Fax:731-885-0588
Practice Address - Street 1:622 E REELFOOT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5739
Practice Address - Country:US
Practice Address - Phone:731-885-0541
Practice Address - Fax:731-885-0588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1210152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0468680001Medicare NSC