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General NPI Number Information
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NPI Number | 1306943519
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Entity Type | Organization
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Legal Business Name | MICHAEL D GORDON OD PA
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8100 E 22ND ST N BLDG 1600
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City | WICHITA
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State | KS
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Zip | 67226
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Country | US
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Telephone | 316-684-2020
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Fax | 316-686-7307
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Provider Business Mailing Address
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Address Line | 8100 E 22ND ST N BLDG 1600
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City | WICHITA
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State | KS
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Zip | 67226
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Country | US
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Telephone | 316-684-2020
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Fax | 316-686-7307
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL D GORDON
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Credential | OD
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Telephone | 316-684-2020
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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 | 10462
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License Number State | KS
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