Provider Demographics
NPI:1427017409
Name:GORDON, ROSS D (OD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:D
Last Name:GORDON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2921 ERIE BLVD EAST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224
Mailing Address - Country:US
Mailing Address - Phone:315-445-7465
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:125 SHOP CITY PLAZA
Practice Address - Street 2:EMPIRE VISION CENTERS
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206
Practice Address - Country:US
Practice Address - Phone:315-463-7700
Practice Address - Fax:315-463-2938
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT0060621152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB5352Medicare ID - Type Unspecified
U44864Medicare UPIN