Provider Demographics
NPI:1295336626
Name:JORDAN G CONLEY OD, LLC
Entity type:Organization
Organization Name:JORDAN G CONLEY OD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-465-7738
Mailing Address - Street 1:12504 US ROUTE 60
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-9687
Mailing Address - Country:US
Mailing Address - Phone:606-929-9432
Mailing Address - Fax:606-929-9622
Practice Address - Street 1:12504 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-9687
Practice Address - Country:US
Practice Address - Phone:606-929-9432
Practice Address - Fax:606-929-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty