Jordan Daniel Booth, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2483 Issued in NC

Practice address

200 Perimeter Park Dr Ste D
Morrisville, NC 27560-9714

Phone

(910) 893-4141

NPI assigned

Nov 16, 2017

Last updated

Dec 17, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Ohio State University - College of Optometry, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clark Optometric Center PAGroup PAC ID 6709911092, 45 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clark Optometric Center PA

  dba Triangle Visions Optometry

  • Optometrist
  • Durham, NC
  • NPI 1588619217
  Medicare reassignment Care Compare group NPD
• Valerie a. Colborn, O.D., P.a.

  • Optometrist
  • Lillington, NC
  • NPI 1235353541
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1510790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576540800000",
    "number": "1447764188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 PERIMETER PARK DR STE D",
            "city": "MORRISVILLE",
            "state": "NC",
            "postal_code": "275609714",
            "telephone_number": "910-893-4141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PERIMETER PARK DR STE D",
            "city": "MORRISVILLE",
            "state": "NC",
            "postal_code": "275609714",
            "telephone_number": "910-893-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "JORDAN",
        "middle_name": "DANIEL",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-16",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "2483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Ann Misko Blanton, O.D.
• Sumana Blask, RPH
• Blooming Mind Therapy
• Katherine Blum, LCMHCA
• Laurie Bolster, MA, LCHMCA
• Tamekia Lekeyia Bordeaux
• George J Borrelli, MD
• Brittany Nicole Bosco, FNP
• Frank G Bottone Jr., PHD, RDN, LDN
• Jonathon David Bouffard, MOT, OTR/L

• Optometrist in Morrisville, NC
• Providers in Morrisville, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.