Provider Demographics
NPI:1952787459
Name:HUGHES, JORDAN WILLIAM (OD, MS)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:WILLIAM
Last Name:HUGHES
Suffix:
Gender:M
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 W 14TH AVE
Mailing Address - Street 2:STE C
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-4860
Mailing Address - Country:US
Mailing Address - Phone:307-399-5365
Mailing Address - Fax:
Practice Address - Street 1:8585 W 14TH AVE
Practice Address - Street 2:STE C
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-4860
Practice Address - Country:US
Practice Address - Phone:307-399-5365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003139152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist