National Provider Identifier
Mark Jay Gordon, OD
Mark Jay Gordon, OD is listed in the NPPES registry with a primary specialty of Optometrist in Kenmore, NY and a listed phone number of (716) 871-0074.
Profile Overview
- NPI
- 1568420099
- Provider Type
- Individual
- Primary Specialty
- Optometrist
- Enumeration Date
- May 03, 2006
- Last Updated
- October 18, 2017
Practice Location
- 978 Colvin Blvd
- Kenmore, NY 14217-2128
Phone: (716) 871-0074
Specialties
- Optometrist (152W00000X)
- Optometrist (152W00000X)
Full Record
- NPI
- 1568420099
- Entity Type
- Individual
- Last Name
- Gordon
- First Name
- Mark
- Middle Name
- Jay
- Name Prefix
- Dr.
- Credential
- OD
- Mailing Street Address
- 978 Colvin Blvd
- Mailing City
- Kenmore
- Mailing State
- NY
- Mailing ZIP Code
- 14217-2128
- Mailing Country
- US
- Mailing Phone
- (716) 871-0074
- Mailing Fax
- (716) 898-8973
- Practice Street Address
- 978 Colvin Blvd
- Practice City
- Kenmore
- Practice State
- NY
- Practice ZIP Code
- 14217-2128
- Practice Country
- US
- Practice Phone
- (716) 871-0074
- Practice Fax
- (716) 898-8973
- Enumeration Date
- May 03, 2006
- Last Updated
- October 18, 2017
- Sex
- Male
- Sole Proprietor
- Yes
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Optometrist (152W00000X), Optometrist (152W00000X)