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General NPI Number Information
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NPI Number | 1104907575
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Entity Type | Individual
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Provider Name | STEVEN PAUL GORDON O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/08/2019
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Provider Practice Location Address
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Address Line | 26300 CEDAR RD STE 2005
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City | BEACHWOOD
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State | OH
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Zip | 44122
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Country | US
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Telephone | 216-514-9777
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Fax | 216-514-0942
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Provider Business Mailing Address
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Address Line | 26300 CEDAR RD STE 2005
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City | BEACHWOOD
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State | OH
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Zip | 44122-1185
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Country | US
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Telephone | 216-514-9777
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Fax | 216-514-0942
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5039
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License Number State | OH
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