Organization
RANDALL W JORDAN OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL W JORDAN OD (PRESIDENT)
(229) 273-0018
Entity
Organization
Contact information
Practice address
1107 E SOUTH GREER STREET, CORDELE, GA 31015
(229) 273-0018
(229) 273-0102
Mailing address
PO BOX 5103, CORDELE, GA 31010-5103
(229) 273-0018
(229) 273-0102
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1192
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00414455F
—
GA
Enumeration date
09/25/2006
Last updated
08/30/2013
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