Provider Demographics
NPI:1982739595
Name:GORDON, ERIC SCOTT (OD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:SCOTT
Last Name:GORDON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 ASHFORD DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-9246
Mailing Address - Country:US
Mailing Address - Phone:229-883-2200
Mailing Address - Fax:
Practice Address - Street 1:1569 US HIGHWAY 19 S
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-4939
Practice Address - Country:US
Practice Address - Phone:229-439-1200
Practice Address - Fax:229-255-2929
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3796152W00000X
GAOPT002106152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist