Provider Demographics
NPI:1730595521
Name:PAUL, JORDAN MAX (OD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MAX
Last Name:PAUL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 HULSE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32508-1089
Mailing Address - Country:US
Mailing Address - Phone:850-452-2933
Mailing Address - Fax:
Practice Address - Street 1:9045 FORSSTROM DR
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6737
Practice Address - Country:US
Practice Address - Phone:303-858-8474
Practice Address - Fax:720-325-1275
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist