Individual
DOUGLAS R JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2943 HIGHWAY 62 W, MOUNTAIN HOME, AR 72653-6535
(870) 424-4900
(870) 424-4979
Mailing address
PO BOX 444, MOUNTAIN HOME, AR 72654-0444
(870) 424-4900
(870) 424-4979
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4021
AR
152W00000X
Optometrist
T 03117
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108285
BLUE CROSS BLUE SHIELD
MO
05
—
244744722
—
AR
05
—
316781608
—
MO
Enumeration date
12/08/2005
Last updated
08/19/2021
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