Tim Jordan, O.D.
Individual provider Active NPI Optometrist · Epping, NH
NPI 1255427068 · NPPES record last updated Jun 22, 2010
Key facts
- NPI
- 1255427068
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 655 (NH)
- Practice address
- 35 Fresh River Rd
Epping, NH 03042-2225 - Phone
- (603) 679-5147
- NPI assigned
- Oct 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- New England College of Optometry, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
35 Fresh River Rd
Epping, NH 03042-2225
Phone (603) 679-5147
PO Box
Suite 376
Epping, NH 03042-0376
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060119000308 | NH | Practitioner - Optometry | 1850315615 | Practice locations: Epping, NH |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 655 | NH | MD | Mental Health Counselor |
| 4033 | MA | MD | Nutritionist |
| 0655 | NH | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 655 | NH | Yes |
| Optometrist | 152W00000X | 4033 | MA |
Addresses
Primary practice location
35 Fresh River Rd
Epping, NH 03042-2225
Mailing address
PO Box 376
Epping, NH 03042-0376
Phone (603) 679-5147
Other providers in Epping, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.