Justin R Gordon, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046006849 Issued in IL

Practice address

3143 W Devon Ave
Chicago, IL 60659-1424

Phone

(773) 764-5300

Fax

(773) 764-2810

NPI assigned

Aug 1, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 1976

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye on Devon IncGroup PAC ID 5799218483, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Practitioners 1

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

• Yair Shlomo Elias, OD

  • Optometrist
  • Lincolnwood, IL
  • NPI 1841501194
  Medicare reassignment

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eye on Devon Inc.

  • Optometrist
  • Lincolnwood, IL
  • NPI 1295103695
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309996800000",
    "number": "1366459711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3143 W DEVON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606591424",
            "telephone_number": "773-764-5300",
            "fax_number": "773-764-2810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3143 W DEVON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606591424",
            "telephone_number": "773-764-5300",
            "fax_number": "773-764-2810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "JUSTIN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2011-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046006849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Lynne Gordon, LAT, ATC
• Jason R Gordon, MD
• Jeffrey Glen Gordon, D.D.S.
• Jill Gordon, MSW, LCSW
• Jonathan Gordon, MD
• Katherine Gordon, CRNA
• Katrina Gordon, MD
• Keya M Gordon, DC
• Laurence R Gordon, DO
• Leo Gordon, MD

• Optometrist in Chicago, IL
• Providers in Chicago, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.