Kenneth Bryce Gordon, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618000495 Issued in VA

Practice address

4811 S Laburnum Ave
Richmond, VA 23231-2713

Phone

(804) 226-1144

Fax

(804) 236-9026

NPI assigned

Jul 7, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in VA

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

Pennsylvania College of Optometry, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dr Clifford Roffis and Associates OdpcGroup PAC ID 4385711191, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Dr Clifford Roffis and Associates Odpc

  • Optometrist
  • Richmond, VA
  • NPI 1184788457
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369094400000",
    "number": "1497752208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4811 S LABURNUM AVE",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232312713",
            "telephone_number": "804-226-1144",
            "fax_number": "804-236-9026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4811 S LABURNUM AVE",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232312713",
            "telephone_number": "804-226-1144",
            "fax_number": "804-236-9026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "KENNETH",
        "middle_name": "BRYCE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2013-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618000495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "DA5536",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE UPIN",
            "identifier": "U84594",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE TAX ID",
            "identifier": "541783118",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9232362",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE TAX ID",
            "identifier": "541783118",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD PROVIDER",
            "identifier": "P00068065",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alysson Rae Gordon, ACNP-BC
• Carter Taylor Gordon, LCSW
• Christina Beausoleil Gordon, DDS
• Derek Andrew Gordon
• Joshua Coleman Gordon, DDS
• Laura M Gordon, MD
• Leteisha Mechi'Ell Gordon
• Martin Blackwell Gordon, LCSW
• Nakeisha Ann Gordon, LPC
• Robert Harrison Gordon Jr., LCSW, M.ED.

• Optometrist in Richmond, VA
• Providers in Richmond, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2013; 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.