Provider Demographics
NPI:1295997674
Name:GORDON EYE ASSOCIATES, INC
Entity type:Organization
Organization Name:GORDON EYE ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YALE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SHRIBER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-674-1400
Mailing Address - Street 1:47 WALTHAM ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-5406
Mailing Address - Country:US
Mailing Address - Phone:781-674-1400
Mailing Address - Fax:
Practice Address - Street 1:47 WALTHAM ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5406
Practice Address - Country:US
Practice Address - Phone:781-674-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA4079152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0015916Medicare PIN