M.D. Gordon O.D., LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1046-3 Issued in KS

Legal business name

M.D. GORDON O.D., LLC

Practice address

8100 E 22ND St N
BLDG. 1600
Wichita, KS 67226-2388

Phone

(316) 684-2020

Fax

(316) 686-7307

NPI assigned

Jan 21, 2011

Last updated

Oct 19, 2016By the provider in NPPES

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, O.D.NPI 1699870212

Title

President

Phone

(316) 684-2020

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael D Gordon, OD

  • Optometrist
  • Wichita, KS
  • NPI 1699870212
  Authorized official Same address or phone

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

{
    "created_epoch": "1295568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476835200000",
    "number": "1588969570",
    "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": "672262388",
            "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": "672262388",
            "telephone_number": "316-684-2020",
            "fax_number": "316-686-7307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M.D. GORDON O.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-21",
        "last_updated": "2016-10-19",
        "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": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KS",
            "license": "1046-3",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Oct 19, 2016; 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.