Provider Demographics
NPI:1861646937
Name:KEITH, JORDAN FREDERICK (OD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:FREDERICK
Last Name:KEITH
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 1:3606 N 156TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2163
Mailing Address - Country:US
Mailing Address - Phone:402-205-0754
Mailing Address - Fax:
Practice Address - Street 1:3606 N 156TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2158
Practice Address - Country:US
Practice Address - Phone:402-205-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-15
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3153152W00000X
NE1589152W00000X
IA116516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist