Provider Demographics
NPI:1336302900
Name:JAMES R GORDON
Entity Type:Organization
Organization Name:JAMES R GORDON
Other - Org Name:JIM GORDON OPTICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRESOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-853-2020
Mailing Address - Street 1:591 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1932
Mailing Address - Country:US
Mailing Address - Phone:508-852-3636
Mailing Address - Fax:508-459-5082
Practice Address - Street 1:591 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1932
Practice Address - Country:US
Practice Address - Phone:508-852-3636
Practice Address - Fax:508-459-5082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier