NPIMap

Organization Active NPI

Developmental Optometrist PC

  • Optometrist
  • Kenmore, NY
National Provider Identifier
1861885451
Registry record updated May 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TUV004506 Issued in NY
Legal business name
DEVELOPMENTAL OPTOMETRIST PC
Practice address
978 Colvin Blvd
Kenmore, NY 14217-2128
Phone
(716) 871-0074
Fax
(716) 878-8973
NPI assigned
Mar 6, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2015

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

Authorized official

Name
Dr. Mark Jay Gordon, OD
Title
Owner
Phone
(716) 871-0074

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X TUV004506 NY Primary

Addresses

Primary practice location

978 Colvin Blvd
Kenmore, NY 14217-2128

Mailing address

978 Colvin Blvd
Kenmore, NY 14217-2128
Phone (716) 871-0074

National Provider Directory

National Provider Directory

Locations

978 Colvin Blvd
Kenmore, NY 14217
Phone (716) 871-0074

NPI Registry JSON

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

{
    "created_epoch": "1425600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432684800000",
    "number": "1861885451",
    "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": "716-878-8973"
        },
        {
            "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": "716-878-8973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEVELOPMENTAL OPTOMETRIST PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-06",
        "last_updated": "2015-05-27",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "716-871-0074",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV004506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenmore, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2015; 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.