Active NPI
Timothy Eugene Gordon, O.D.
- Optometrist
- Santa Fe, NM
National Provider Identifier
1053324988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2274
- Practice address
- 5701 Herrera Dr
Santa Fe, NM 87507-2677 - Phone
- (505) 424-9139
- Fax
- (505) 424-1384
- NPI assigned
- Aug 14, 2006
- Last updated
- Sep 27, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2274 | NM | Primary |
Addresses
Primary practice location
5701 Herrera Dr
Santa Fe, NM 87507-2677
Mailing address
PO Box 22683
Santa Fe, NM 87502-2683
Phone (575) 639-4767
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000P4328 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2274 | NM | MD | Optometrist |
| 274 | NM | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380240000000",
"number": "1053324988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 22683",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875022683",
"telephone_number": "575-639-4767",
"fax_number": "505-424-1384"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5701 HERRERA DR",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875072677",
"telephone_number": "505-424-9139",
"fax_number": "505-424-1384"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "TIMOTHY",
"middle_name": "EUGENE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2013-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NM",
"license": "2274",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000P4328",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Fe, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.