Provider Demographics
NPI:1699125765
Name:MUIR, JORDAN DIANE (OD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:DIANE
Last Name:MUIR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 GATEWAY DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3509
Mailing Address - Country:US
Mailing Address - Phone:701-235-0280
Mailing Address - Fax:701-235-3326
Practice Address - Street 1:1300 GATEWAY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3509
Practice Address - Country:US
Practice Address - Phone:701-235-0280
Practice Address - Fax:701-235-3326
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3479152W00000X
ND747152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist