Provider Demographics
NPI:1235121153
Name:GORDON, SARAH C (OD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:C
Last Name:GORDON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13521 OLD HIGHWAY 280
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-1405
Mailing Address - Country:US
Mailing Address - Phone:205-266-2137
Mailing Address - Fax:
Practice Address - Street 1:13521 OLD HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-1405
Practice Address - Country:US
Practice Address - Phone:205-266-2137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMG0173168152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68920Medicare UPIN
AL5001790001Medicare NSC
AL051503147Medicare PIN