Jordan Kain Stidham, OD is a medicare enrolled "Optometrist" provider in Mendota Heights, Minnesota. His current practice location is
740 Main St Ste 100, Mendota Heights, Minnesota. You can reach out to his office (for appointments etc.) via phone at
(651) 686-9393.
Jordan Kain Stidham is licensed to practice in Minnesota (license number 3735) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1578016184.
Healthcare Provider's Profile
| Full Name | Jordan Kain Stidham |
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| Gender | Male |
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| Speciality | Optometrist |
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| Location | 740 Main St Ste 100, Mendota Heights, Minnesota |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1578016184
- Provider Enumeration Date: 07/31/2016
- Last Update Date: 12/08/2022
Medicare PECOS Information:
- PECOS PAC ID: 7012374408
- Enrollment ID: I20230530002235
Medical Identifiers
Medical identifiers for Jordan Kain Stidham such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1578016184 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 152W00000X | Optometrist | OPT.6498 (Ohio) | Secondary |
| 152W00000X | Optometrist | 3735 (Minnesota) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jordan Kain Stidham allows following entities to bill medicare on his behalf.
| Provider Name | Eagan Eye Clinic Llc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1477732337
PECOS PAC ID: 0345220745
Enrollment ID: O20040726000300 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jordan Kain Stidham is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Jordan Kain Stidham, OD
740 Main St Ste 100,
Mendota Heights, MN 55118-3763
Ph: (651) 686-9393 | Jordan Kain Stidham, OD
740 Main St Ste 100,
Mendota Heights, MN 55118-3763
Ph: (651) 686-9393 |
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