=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902821382
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA ANN GORDEUK O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2006
-----------------------------------------------------
Last Update Date | 07/30/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38 WEST RD
-----------------------------------------------------
City | NEWTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18940-4301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-968-0203
-----------------------------------------------------
Fax | 215-504-1344
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4899 DURHAM RD
-----------------------------------------------------
City | PIPERSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-229-4242
-----------------------------------------------------
Fax | 215-504-1344
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 0E006881T
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 04955
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | T0325
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------