Active NPI
Marc Aaron Gordon, O.D.
- Optometrist
- Corona, NY
National Provider Identifier
1679641062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- TUV007126-1
- Practice address
- 10219 Roosevelt Ave
Corona, NY 11368-2331 - Phone
- (718) 290-3566
- Fax
- (718) 507-2729
- NPI assigned
- Dec 1, 2006
- Last updated
- Apr 29, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPC4132 | FL | |
| Optometrist | 152W00000X | TUV007126-1 | NY | Primary |
| Optometrist | 152W00000X | 27OA00619000 | NJ |
Addresses
Primary practice location
10219 Roosevelt Ave
Corona, NY 11368-2331
Mailing address
10219 Roosevelt Ave
Corona, NY 11368-2331
Phone (718) 290-3566
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007126 | NY | MD | Mental Health Counselor |
| 27OA00619000 | NJ | MD | Optometrist |
| TUV007126-1 | NY | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| National Vision Care Center Inc | Optometrist | Past | Accepting new patients |
| National Vision Care Center Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304035200000",
"number": "1679641062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10219 ROOSEVELT AVE",
"city": "CORONA",
"state": "NY",
"postal_code": "113682331",
"telephone_number": "718-290-3566",
"fax_number": "718-507-2729"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10219 ROOSEVELT AVE",
"city": "CORONA",
"state": "NY",
"postal_code": "113682331",
"telephone_number": "718-290-3566",
"fax_number": "718-507-2729"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "MARC",
"middle_name": "AARON",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-01",
"last_updated": "2011-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "OPC4132",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "TUV007126-1",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NJ",
"license": "27OA00619000",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.