Provider Demographics
NPI:1992937262
Name:PIERCE, JORDAN JAMISON (OD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:JAMISON
Last Name:PIERCE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5310 N TARRANT PKWY
Mailing Address - Street 2:STE 128
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5386
Mailing Address - Country:US
Mailing Address - Phone:817-514-2114
Mailing Address - Fax:817-514-2150
Practice Address - Street 1:5310 N TARRANT PKWY
Practice Address - Street 2:STE 128
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5386
Practice Address - Country:US
Practice Address - Phone:817-514-2114
Practice Address - Fax:817-514-2150
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX7417TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208059002Medicaid
TXTXB102635OtherMEDICARE PART B PROVIDER