Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 108457 | IA |
NPI | 1013584549 |
---|---|
Provider Name | Dr. Jordan L Ukena |
First Address | Ankeny, IA 50023-1754 |
Second Address | Johnston, IA 50131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2021 |
Last Update Date | 03/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
108457 | STATE LICENSE (01) | IA |