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General NPI Number Information
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NPI Number | 1356876643
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Entity Type | Organization
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Legal Business Name | DR. GORDING,OPTOMETRY, P.C.
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Dates
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Enumeration Date | 04/25/2017
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 2035 WESTWOOD BLVD SUITE 101
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City | LOS ANGELES
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State | CA
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Zip | 90025-6332
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Country | US
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Telephone | 310-470-4289
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Fax |
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Provider Business Mailing Address
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Address Line | 2035 WESTWOOD BLVD SUITE 101
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City | LOS ANGELES
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State | CA
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Zip | 90025-6332
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Country | US
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Telephone | 310-470-4289
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONATHAN GORDING
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Credential | O.D.
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Telephone | 310-470-4289
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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 | 6674TPG
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License Number State | CA
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