Provider Demographics
NPI:1336378561
Name:GORDON, SARI LEE (OD)
Entity Type:Individual
Prefix:MRS
First Name:SARI
Middle Name:LEE
Last Name:GORDON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085D NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1632
Mailing Address - Country:US
Mailing Address - Phone:516-365-4066
Mailing Address - Fax:516-365-9312
Practice Address - Street 1:1085D NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1632
Practice Address - Country:US
Practice Address - Phone:516-365-4066
Practice Address - Fax:516-365-9312
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004015152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management