Provider Demographics
NPI:1194343848
Name:GJOLBERG, JORDAN ELIZABETH (OD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ELIZABETH
Last Name:GJOLBERG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:ELIZABETH
Other - Last Name:SPEIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5700 TAPADERA TRACE LN APT 1016
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-6317
Mailing Address - Country:US
Mailing Address - Phone:512-942-9191
Mailing Address - Fax:
Practice Address - Street 1:800 CRYSTAL FALLS PKWY UNIT 4
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-3670
Practice Address - Country:US
Practice Address - Phone:512-260-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9957T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist