Provider Demographics
NPI:1235197062
Name:GORDON & SILVERS ODS
Entity Type:Organization
Organization Name:GORDON & SILVERS ODS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:818-986-8860
Mailing Address - Street 1:16255 VENTURA BLVD
Mailing Address - Street 2:STE 705
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-986-8860
Mailing Address - Fax:818-986-7324
Practice Address - Street 1:16255 VENTURA BLVD
Practice Address - Street 2:STE 705
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:818-986-8860
Practice Address - Fax:818-986-7324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY48587YMedicaid
WY1488Medicare ID - Type Unspecified