Provider Demographics
NPI:1851488241
Name:BROOKS, JORDAN TROTTER (OD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:TROTTER
Last Name:BROOKS
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 1:8890 SALROSE LN
Mailing Address - Street 2:SUITE #203
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-2085
Mailing Address - Country:US
Mailing Address - Phone:239-313-6011
Mailing Address - Fax:239-313-6052
Practice Address - Street 1:8890 SALROSE LN
Practice Address - Street 2:SUITE #203
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-2085
Practice Address - Country:US
Practice Address - Phone:239-313-6011
Practice Address - Fax:239-313-6052
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4115152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621160700Medicaid
FLAB384Medicare PIN