Provider Demographics
NPI:1033303052
Name:GORDON W. DYER, LLC
Entity Type:Organization
Organization Name:GORDON W. DYER, LLC
Other - Org Name:GORDON W. DYER, O.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:432-689-7070
Mailing Address - Street 1:4511 N MIDKIFF RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-3256
Mailing Address - Country:US
Mailing Address - Phone:432-689-7070
Mailing Address - Fax:432-699-1279
Practice Address - Street 1:4517 N MIDLAND DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3325
Practice Address - Country:US
Practice Address - Phone:432-689-7070
Practice Address - Fax:432-699-1279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-03
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5490T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU18570Medicare UPIN