Jordan Kain Stidham, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3735 Issued in MN

Practice address

225 SE Main St
Minneapolis, MN 55414-2124

Phone

(612) 379-1555

NPI assigned

Jul 31, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eagan Eye Clinic LLCGroup PAC ID 0345220745, 48 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 and National Provider Directory roles.

• Eagan Eye Clinic LLC

  • Optometrist
  • Eagan, MN
  • NPI 1477732337
  Medicare reassignment Care Compare group NPD
• Eagan Eye Clinic LLC

  • Optometrist
  • Becker, MN
  • NPI 1023615069
  NPD

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

{
    "created_epoch": "1469923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716940800000",
    "number": "1578016184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 MAIN ST STE 100",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "551183763",
            "telephone_number": "651-686-9393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 SE MAIN ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554142124",
            "telephone_number": "612-379-1555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STIDHAM",
        "first_name": "JORDAN",
        "middle_name": "KAIN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-31",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "OPT.6498",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheryl Edin Stibbe, RN, MAN
• Shawna Stich, MSW, LGSW
• Emma Sophia Sticha
• Kristyn Sandra Stickley
• Emily Ann Stickney, MD
• Kevin Todd Stieglbauer, MD
• Matthew John Stiehm, MA
• Crystal Lynn Stien, P.T.
• Mary Stiennon
• Claire Stiff

• Optometrist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; 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.