Provider Demographics
NPI:1962293332
Name:FLEMONS, JORDYN MICHELLE
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:MICHELLE
Last Name:FLEMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1653 RIVER RUN STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6680
Mailing Address - Country:US
Mailing Address - Phone:817-727-4555
Mailing Address - Fax:
Practice Address - Street 1:1653 RIVER RUN STE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6680
Practice Address - Country:US
Practice Address - Phone:817-727-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11384152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty