Provider Demographics
NPI:1003360462
Name:ALEXANDER, JORDAN LEE ELLIS (OD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:LEE ELLIS
Last Name:ALEXANDER
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W FM 1382 STE 524B
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1890
Mailing Address - Country:US
Mailing Address - Phone:972-293-7170
Mailing Address - Fax:
Practice Address - Street 1:305 W FM 1382 STE 524B
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1890
Practice Address - Country:US
Practice Address - Phone:972-293-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9247152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist