Provider Demographics
NPI:1700020252
Name:GORDON, JANET NELSON (OD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:NELSON
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 1:632 GRASSFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-7449
Mailing Address - Country:US
Mailing Address - Phone:757-547-2040
Mailing Address - Fax:757-547-2042
Practice Address - Street 1:632 GRASSFIELD PKWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-7449
Practice Address - Country:US
Practice Address - Phone:757-547-2040
Practice Address - Fax:757-547-2042
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000996152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist