MEDICARE: DR. ROSS D GORDON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	T0060621	NY

General Provider Information

NPI Number	:	1427017409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSS D GORDON OD

Provider Business Mailing Address
First Line	:	2921 ERIE BLVD EAST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13224
Country	:	US
Telephone Number	:	315-445-7465
Fax Number	:	315-445-7675

Provider Business Practice Location Address
First Line	:	125 SHOP CITY PLAZA
Second Line	:	EMPIRE VISION CENTERS
City	:	SYRACUSE
State	:	NY
Zip	:	13206
Country	:	US
Telephone Number	:	315-463-7700
Fax Number	:	315-463-2938

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	07/08/2007

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