Provider Demographics
NPI:1881076651
Name:NETZEL, JORDAN MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:MICHAEL
Last Name:NETZEL
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:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-0188
Mailing Address - Country:US
Mailing Address - Phone:479-427-0398
Mailing Address - Fax:
Practice Address - Street 1:960 S MOUNT OLIVE ST STE A
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-4204
Practice Address - Country:US
Practice Address - Phone:479-524-5161
Practice Address - Fax:479-524-8046
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2717152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist