Provider Demographics
NPI:1174597199
Name:JORDAN, JOSEPH J JR (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:JORDAN
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LILAC MALL
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-1350
Mailing Address - Country:US
Mailing Address - Phone:603-335-6666
Mailing Address - Fax:
Practice Address - Street 1:8 LILAC MALL
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-1350
Practice Address - Country:US
Practice Address - Phone:603-335-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0495152W00000X
MA3093152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH40009434Medicaid
NA1153OtherHARVARD PILGRIM PROVIDER
020493870OtherTAX ID
NH0907469Y0NH01OtherBCBS PROVIDER NUMBER
7515834OtherCIGNA PROVIDER
NH0907469Y0NH01OtherBCBS PROVIDER NUMBER
NHT25848Medicare UPIN