Mark Jay Gordon, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

NY TUV004506 Issued in NY

Practice address

978 Colvin Blvd
Kenmore, NY 14217-2128

Phone

(716) 871-0074

Fax

(716) 898-8973

NPI assigned

May 3, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508284800000",
    "number": "1568420099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "978 COLVIN BLVD",
            "city": "KENMORE",
            "state": "NY",
            "postal_code": "142172128",
            "telephone_number": "716-871-0074",
            "fax_number": "716-898-8973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "978 COLVIN BLVD",
            "city": "KENMORE",
            "state": "NY",
            "postal_code": "142172128",
            "telephone_number": "716-871-0074",
            "fax_number": "716-898-8973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "MARK",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2017-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "NY TUV004506",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV004506",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Ann Gooch, MD
• Good Neighbors Dental Group PLLC
• Terri L Good, LMSW
• James Patrick Goode, PA-S
• Leslie FZ Gordon, MSED
• Jasmine Graves
• Great Lakes Locums LLC
• Lauren Helena Greatrix, OTR/L
• Owen Green, PT, DPT
• Tayauna Green

• Optometrist in Kenmore, NY
• Providers in Kenmore, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2017; 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.