| NPI | 1902231640 |
|---|---|
| Other Name | JORDAN RIDGEWAY |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2512) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618002368) |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2018-05-15 |