Mark B Gordon, O.D.
Individual provider Active NPI Optometrist · Baltimore, MD
NPI 1821028382 · NPPES record last updated Mar 21, 2008
Key facts
- NPI
- 1821028382
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- TA0633 (MD)
- Practice address
- 100 Park Ave
Baltimore, MD 21201-3416 - Phone
- (410) 752-1677
- Fax
- (410) 752-4435
- NPI assigned
- Jul 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Pennsylvania College of Optometry, 1971
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Barenburg Optical Service, Inc
Practice addresses (Care Compare)
100 Park Ave
Baltimore, MD 21201-3416
Phone (410) 727-0285
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040309001379 | MD | Practitioner - Optometry | 1951299049 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TA0633 | MD | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Barenburg Optical Service, Inc | Optometrist | Current |
Accepting new patients |
| Barenburg Optical Service, Inc | Optometrist | Past | Accepting new patients |
| Barenburg Optical Service, Inc | Optometrist | Past | Accepting new patients |
| Barenburg Optical Service, Inc | Optometrist | Past | Accepting new patients |
| Barenburg Optical Service, Inc | Past | Accepting new patients | |
| Barenburg Optical Service, Inc | Optometrist | Past | Accepting new patients |
| Barenburg Optometric Service, Inc | Past | Accepting new patients |
Locations
100 Park Ave
Baltimore, MD 21201
Phone (410) 727-0285
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TA0633 | MD | Yes |
Addresses
Primary practice location
100 Park Ave
Baltimore, MD 21201-3416
Mailing address
100 Park Ave
Baltimore, MD 21201-3416
Phone (410) 752-1677
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 522190 | Other | MD | BCBS |
| S017-0006 | Other | MD | BLUECHOICE |
Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 21, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.