Provider Demographics
NPI:1639316490
Name:DR JANET I GORDON
Entity Type:Organization
Organization Name:DR JANET I GORDON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALOMOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1360-694-0760
Mailing Address - Street 1:7017 NE HIGHWAY 99 STE 202
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-0553
Mailing Address - Country:US
Mailing Address - Phone:136-069-4076
Mailing Address - Fax:136-069-4109
Practice Address - Street 1:7017 NE HIGHWAY 99 STE 202
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-0553
Practice Address - Country:US
Practice Address - Phone:136-069-4076
Practice Address - Fax:136-069-4109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 00017326152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0927880001Medicare NSC