Provider Demographics
NPI:1386482669
Name:MOCZYGEMBA, JORDAN EMMA (OD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:EMMA
Last Name:MOCZYGEMBA
Suffix:
Gender:F
Credentials:OD
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Other - Credentials:
Mailing Address - Street 1:9789 KATY FWY APT 1109
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1372
Mailing Address - Country:US
Mailing Address - Phone:210-473-6785
Mailing Address - Fax:
Practice Address - Street 1:8220 LOUETTA RD STE 112
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7021
Practice Address - Country:US
Practice Address - Phone:281-370-2020
Practice Address - Fax:281-251-2705
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX11133T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist