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NPI Code Detail

MEDICARE: JONATHAN E GORDON OD PA

MEDICARE: JONATHAN E GORDON OD PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOPC 3471FL

General Provider Information

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

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