Michael D Gordon OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

10462 Issued in KS

Legal business name

MICHAEL D GORDON OD PA

Practice address

8100 E 22ND St N
BLDG 1600
Wichita, KS 67226

Phone

(316) 684-2020

Fax

(316) 686-7307

NPI assigned

Sep 20, 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, ODNPI 1699870212

Title

President

Phone

(316) 684-2020

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael D Gordon, OD

  • Optometrist
  • Wichita, KS
  • NPI 1699870212
  NPD (past) Authorized official

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306943519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8100 E 22ND ST N",
            "address_2": "BLDG 1600",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "67226",
            "telephone_number": "316-684-2020",
            "fax_number": "316-686-7307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8100 E 22ND ST N",
            "address_2": "BLDG 1600",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "67226",
            "telephone_number": "316-684-2020",
            "fax_number": "316-686-7307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL D GORDON OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-08-22",
        "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "KS",
            "license": "10462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA MEDICARE",
            "identifier": "0254820002",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "017087",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maliyah Meza
• MHV Strickland MD PA
• Mi Casa Care Homes - Tyler LLC
• Miacare Medical Services, LLC
• Michael Baker
• Michael F Lloyd DO PA
• Michael H. Munhall, M.D.
• Michael M Vesali MD P a
• Michael M. Vesali MD, P.a
• Michael N Williams DDS PA

• Optometrist in Wichita, KS
• Providers in Wichita, KS by specialty
• Optometrist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.