Provider Demographics
NPI:1538438619
Name:JORDAN, STEVEN
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:JORDAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4452
Mailing Address - Country:US
Mailing Address - Phone:954-491-5818
Mailing Address - Fax:954-491-5819
Practice Address - Street 1:235 COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-4452
Practice Address - Country:US
Practice Address - Phone:954-491-5818
Practice Address - Fax:954-491-5819
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO3073156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician