Individual provider Active NPI

Eric Scott Gordon, O.D.

  • Optometrist
  • Leesburg, GA
National Provider Identifier
1982739595
Registry record updated Sep 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT002106 Issued in GA
Practice address
1569 US Highway 19 S
Leesburg, GA 31763-4939
Phone
(229) 439-1200
Fax
(229) 255-2929
NPI assigned
Feb 22, 2007
Last updated
Sep 7, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC3796 FL
Optometrist 152W00000X OPT002106 GA Primary

Addresses

Primary practice location

1569 US Highway 19 S
Leesburg, GA 31763-4939

Mailing address

2405 Ashford Dr
Albany, GA 31721-9246
Phone (229) 883-2200

Other practice location 1

15196 US Highway 19 S
Thomasville, GA 31757-4820
Phone (229) 228-4770

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110314000154 GA Practitioner - Optometry 1658553672 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Nova Southeastern Univ College of Dental Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of Georgia, LLCGroup PAC ID 8224261201, 100 clinicians

Practice addresses (Care Compare)

15196 US Hwy 19 S
Thomasville, GA 31757-4820
Phone (229) 228-4770

1569 Hwy 19 S
Leesburg, GA 31763
Phone (229) 439-1200

4875 Altama Ave
Brunswick, GA 31520-2912
Phone (912) 554-0010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC3796FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Georgia, LLC Optometrist CurrentSince Oct 3, 2022 Accepting new patients
Lee County Optical LLC Optometrist CurrentSince Mar 4, 2013 Accepting new patients
Myeyedr Optometry of Georgia, LLC Optometrist CurrentSince Oct 3, 2022 Accepting new patients
Myeyedr Optometry of Georgia, LLC Optometrist Current Accepting new patients
Myeyedr Optometry of Georgia, LLC Optometrist Past Accepting new patients

Locations

2610 Dawson Rd
Albany, GA 31707
Phone (229) 439-4687

4875 Altama Ave
Brunswick, GA 31520
Phone (912) 554-0010

1569 US Highway 19 S
Leesburg, GA 31763
Phone (229) 439-1200

15196 US Highway 19 S
Thomasville, GA 31757
Phone (229) 228-4770

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Interoperability endpoints

  • Direct secure messaging: eric.gordon@direct.revolutionehr.com

Organizations & group practices 5

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": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662508800000",
    "number": "1982739595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2405 ASHFORD DR",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317219246",
            "telephone_number": "229-883-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1569 US HIGHWAY 19 S",
            "city": "LEESBURG",
            "state": "GA",
            "postal_code": "317634939",
            "telephone_number": "229-439-1200",
            "fax_number": "229-255-2929"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15196 US Highway 19 S",
            "address_purpose": "LOCATION",
            "city": "Thomasville",
            "state": "GA",
            "postal_code": "317574820",
            "country_code": "US",
            "telephone_number": "229-228-4770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "ERIC",
        "middle_name": "SCOTT",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-22",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC3796",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesburg, GA

Sources for this page

Verify at the official NPI Registry.