Provider Demographics
NPI:1407846645
Name:GORDON, ALAN N (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:N
Last Name:GORDON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 45TH AVE
Mailing Address - Street 2:SUITE I
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3962
Mailing Address - Country:US
Mailing Address - Phone:219-924-8012
Mailing Address - Fax:219-924-8170
Practice Address - Street 1:1650 45TH AVE
Practice Address - Street 2:SUITE I
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3962
Practice Address - Country:US
Practice Address - Phone:219-924-8012
Practice Address - Fax:219-924-8170
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001595B152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision