Provider Demographics
NPI:1417940552
Name:GORDON, GAIL C (OD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:C
Last Name:GORDON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:225 E LEE AVE
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-8227
Mailing Address - Country:US
Mailing Address - Phone:336-679-2931
Mailing Address - Fax:336-677-6486
Practice Address - Street 1:225 E LEE AVE
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055
Practice Address - Country:US
Practice Address - Phone:336-679-2931
Practice Address - Fax:336-677-6486
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1931152W00000X
TN2433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1931OtherOD LICENSE
2474157BOtherMEDICARE - YADKINVILLE
511078OtherOE TRACKER
2474157COtherMEDICARE - EAST BEND
NC5905423Medicaid
1417940552OtherNPI
1417940552OtherNPI
V00694Medicare UPIN