Organization Active NPI

William D. Gordon, O.D. Inc.

  • Optometrist
  • Monroe, LA
National Provider Identifier
1407054901
Registry record updated Aug 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
LA909-230T Issued in LA
Legal business name
WILLIAM D. GORDON, O.D. INC.
Practice address
3000 Forsythe Ave
Monroe, LA 71201-3012
Phone
(318) 807-2020
Fax
(318) 388-1868
NPI assigned
Jul 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2011

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

Authorized official

Name
Dr. William David Gordon, ODNPI 1528050069
Title
Doctor of Optometry
Phone
(318) 807-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X LA909-230T LA Primary

Addresses

Primary practice location

3000 Forsythe Ave
Monroe, LA 71201-3012

Mailing address

3000 Forsythe Ave
Monroe, LA 71201-3012
Phone (318) 807-2020

Other identifiers 1

IdentifierTypeStateIssuer
1337170MedicaidLA

Other names 1

  • Family Eye Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050120000097 LA Part B Supplier - Clinic/Group Practice 0446209118 Receives reassigned benefits from 4 practitioners
Practice locations: Monroe, LA

National Provider Directory

National Provider Directory

Locations

1804 N 18th St
Monroe, LA 71201
Phone (318) 325-9474

3000 Forsythe Ave
#5150
Monroe, LA 71201

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1183593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312848000000",
    "number": "1407054901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 FORSYTHE AVE",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712013012",
            "telephone_number": "318-807-2020",
            "fax_number": "318-388-1868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 FORSYTHE AVE",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712013012",
            "telephone_number": "318-807-2020",
            "fax_number": "318-388-1868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM D. GORDON, O.D. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-05",
        "last_updated": "2011-08-09",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "DOCTOR OF OPTOMETRY",
        "authorized_official_telephone_number": "318-807-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "LA",
            "license": "LA909-230T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1337170",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroe, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.