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General NPI Number Information
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NPI Number | 1255528584
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Entity Type | Organization
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Legal Business Name | JONATHAN E GORDON OD PA
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 777 E MERRITT ISLAND CSWY #221
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-3576
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Country | US
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Telephone | 321-454-4800
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Fax | 321-454-2019
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Provider Business Mailing Address
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Address Line | 777 E MERRITT ISLAND CSWY #221
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-3576
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Country | US
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Telephone | 321-454-4800
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Fax | 321-454-2019
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Authorized Official
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Title or Position | P/D/C
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Name | DR. JONATHAN E GORDON
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Credential | O.D.
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Telephone | 321-454-4800
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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 | OPC 3471
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License Number State | FL
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