Active NPI
David Lee Jordan, OD
- Optometrist
- Shreveport, LA
National Provider Identifier
1730143371
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 8931017
- Practice address
- 2601 Jewella
Shreveport, LA 71109 - Phone
- (318) 631-5511
- NPI assigned
- Apr 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 8931017 | LA | Primary |
Addresses
Primary practice location
2601 Jewella
Shreveport, LA 71109
Mailing address
2601 Jewella
Shreveport, LA 71109
Phone (318) 631-5511
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1314561 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100928001561 | LA | Practitioner - Optometry | 7517083496 | Practice locations: Shreveport, LA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 893 | LA | MD | Addiction (Substance Use Disorder) Counselor |
| 8931017 | LA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1385078400000",
"number": "1730143371",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2601 JEWELLA",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "71109",
"telephone_number": "318-631-5511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2601 JEWELLA",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "71109",
"telephone_number": "318-631-5511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "DAVID",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-12",
"last_updated": "2013-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "LA",
"license": "8931017",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1314561",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2013; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.