Provider Demographics
NPI:1881726305
Name:R. GRIFF GORDY PC
Entity type:Organization
Organization Name:R. GRIFF GORDY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:GRIFFITH
Authorized Official - Last Name:GORDY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-303-6336
Mailing Address - Street 1:1756 EDINBURGH ST
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-3614
Mailing Address - Country:US
Mailing Address - Phone:334-303-6336
Mailing Address - Fax:
Practice Address - Street 1:5009 RIVER CHASE DR
Practice Address - Street 2:BUILDING 100 SUITE B
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-7425
Practice Address - Country:US
Practice Address - Phone:334-303-6336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-A51-TA-630152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty