Individual provider Active NPI

Wess Michael Jordan, O.D.

  • Optometrist
  • Las Vegas, NV
National Provider Identifier
1770895039
Registry record updated Dec 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
674 Issued in NV
Practice address
7560 W Lake Mead Blvd Ste 2
Las Vegas, NV 89128-1050
Phone
(702) 654-2020
Fax
(702) 360-4087
NPI assigned
Jul 2, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 674 NV Primary

Addresses

Primary practice location

7560 W Lake Mead Blvd Ste 2
Las Vegas, NV 89128-1050

Mailing address

7560 W Lake Mead Blvd Ste 2
Las Vegas, NV 89128-1050
Phone (702) 654-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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

Enrollment IDStateProvider typePAC IDDetails
I20120301000190 NV Practitioner - Optometry 9234397704 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optic Gallery Summerlin, IncGroup PAC ID 2062679053, 3 clinicians

Practice addresses (Care Compare)

7560 W Lake Mead Blvd
Suite 2
Las Vegas, NV 89128-1050
Phone (702) 654-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
674NVMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Optic Gallery Summerlin, Inc Optometrist CurrentSince Dec 27, 2011 Accepting new patients

Locations

7560 W Lake Mead Blvd
Ste 2
Las Vegas, NV 89128
Phone (702) 654-2020

7450 W Lake Mead Blvd
Ste 2
Las Vegas, NV 89128
Phone (702) 654-2020

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1278028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670976000000",
    "number": "1770895039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7560 W LAKE MEAD BLVD STE 2",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891281050",
            "telephone_number": "702-654-2020",
            "fax_number": "702-360-4087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7560 W LAKE MEAD BLVD STE 2",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891281050",
            "telephone_number": "702-654-2020",
            "fax_number": "702-360-4087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "WESS",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-07-02",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NV",
            "license": "674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.