Douglas R Jordan, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4021 Issued in AR

Practice address

2943 Highway 62 W
Mountain Home, AR 72653-6535

Phone

(870) 424-4900

Fax

(870) 424-4979

NPI assigned

Dec 8, 2005

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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in AR

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: douglas.jordan.p2@direct.kilgorevisioncenter.nextgenshare.com
• Direct secure messaging: dougjordan@vision-clinic-branson.direct.kno2fy.com

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.

• Kilgore Vision Center

  • Specialist
  • Mountain Home, AR
  • NPI 1447253273

  Optometrist

  Medicare reassignment NPD

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

{
    "created_epoch": "1134000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1790760197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 444",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726540444",
            "telephone_number": "870-424-4900",
            "fax_number": "870-424-4979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2943 HIGHWAY 62 W",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726536535",
            "telephone_number": "870-424-4900",
            "fax_number": "870-424-4979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "DOUGLAS",
        "middle_name": "R",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-08",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T 03117",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "4021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "108285",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "244744722",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "316781608",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christa Jones, QBHP
• Jasmin Jones
• Kenneth A Jones, M.D.
• Leah Elizabeth Jones
• Lockie Jones, LCSW
• Joseph Long DC PA
• Joshua Medley Counseling PLLC
• Saundra Judy, MHPP
• Carine Kamdem Kamdem, PHARMD
• Patrice Marie Kearsey, ANP

• Optometrist in Mountain Home, AR
• Providers in Mountain Home, AR by specialty
• Optometrist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; 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.

Verify at the official NPI Registry.