Michael D Gordon OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

10462 MICHAEL D GORD Issued in KS

Legal business name

MICHAEL D GORDON OD PA

Practice address

1221 N Rock Rd
Derby, KS 67037-3678

Phone

(316) 788-2020

Fax

(316) 788-7451

NPI assigned

Oct 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael D Gordon, OD

Title

President

Phone

(316) 684-2020

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203897600000",
    "number": "1306931472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 N ROCK RD",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670373678",
            "telephone_number": "316-788-2020",
            "fax_number": "316-788-7451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 N ROCK RD",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670373678",
            "telephone_number": "316-788-2020",
            "fax_number": "316-788-7451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL D GORDON OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2008-02-25",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "316-684-2020",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "KS",
            "license": "10462 MICHAEL D GORD",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Derby, KS
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• Optometrist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.