Provider Demographics
NPI:1336706985
Name:CLABOINE, JORDAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:CLABOINE
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 1:1100 SAINT CHARLES PL APT 518
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3326
Mailing Address - Country:US
Mailing Address - Phone:407-484-3429
Mailing Address - Fax:
Practice Address - Street 1:5407 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5210
Practice Address - Country:US
Practice Address - Phone:954-973-3584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist