Individual
JORDAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2800 ROSS CLARK CIR, DOTHAN, AL 36301-2040
(334) 792-2211
Mailing address
2800 ROSS CLARK CIR, DOTHAN, AL 36301-2040
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OPC5588
FL
152W00000X
Optometrist
OPT003122
GA
152W00000X
Optometrist
Primary
S-E18-TA-B35
AL
Other
Enumeration date
08/31/2018
Last updated
08/31/2018
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