MEDICARE: DR. GAIL C GORDON O.D.

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
1	152W00000X	Optometrist	1931	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2474157B	OTHER		MEDICARE - YADKINVILLE
4	2474157C	OTHER		MEDICARE - EAST BEND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1931	OTHER	NC	OD LICENSE
3	511078	OTHER		OE TRACKER
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	1417940552	OTHER		NPI

General Provider Information

NPI Number	:	1417940552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAIL C GORDON O.D.

Provider Business Mailing Address
First Line	:	225 E LEE AVE
Second Line	:
City	:	YADKINVILLE
State	:	NC
Zip	:	27055-8227
Country	:	US
Telephone Number	:	336-679-2931
Fax Number	:	336-677-6486

Provider Business Practice Location Address
First Line	:	225 E LEE AVE
Second Line	:
City	:	YADKINVILLE
State	:	NC
Zip	:	27055
Country	:	US
Telephone Number	:	336-679-2931
Fax Number	:	336-677-6486

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	03/07/2023

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Directions to “ DR. GAIL C GORDON O.D.” Practice Location

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