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General NPI Number Information
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NPI Number | 1336173418
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Entity Type | Individual
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Provider Name | JONATHAN E GORDON O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 06/11/2014
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Provider Practice Location Address
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Address Line | 4320 W BROWARD BLVD SUITE 2
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City | PLANTATION
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State | FL
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Zip | 33317-3756
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Country | US
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Telephone | 954-583-1311
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Fax | 954-587-4448
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Provider Business Mailing Address
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Address Line | 4320 W BROWARD BLVD SUITE 2
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City | PLANTATION
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State | FL
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Zip | 33317-3756
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Country | US
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Telephone | 954-583-1311
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Fax | 954-587-4448
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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 | OPC 3471
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License Number State | FL
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