Provider Demographics
NPI:1407054901
Name:WILLIAM D. GORDON, O.D. INC.
Entity Type:Organization
Organization Name:WILLIAM D. GORDON, O.D. INC.
Other - Org Name:FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:318-807-2020
Mailing Address - Street 1:3000 FORSYTHE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3012
Mailing Address - Country:US
Mailing Address - Phone:318-807-2020
Mailing Address - Fax:318-388-1868
Practice Address - Street 1:3000 FORSYTHE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3012
Practice Address - Country:US
Practice Address - Phone:318-807-2020
Practice Address - Fax:318-388-1868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA909-230T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1337170Medicaid
LA0751220001Medicare NSC
LA1337170Medicaid
LAT-19419Medicare UPIN