Provider Demographics
NPI:1194607432
Name:THOMAS, JORDAN R (OD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-5553
Mailing Address - Country:US
Mailing Address - Phone:701-252-5000
Mailing Address - Fax:701-952-5005
Practice Address - Street 1:210 10TH ST SE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-5553
Practice Address - Country:US
Practice Address - Phone:701-252-5000
Practice Address - Fax:701-952-5005
Is Sole Proprietor?:No
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND836152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist