National Provider Identifier
Developmental Optometrist PC
Developmental Optometrist PC is listed in the NPPES registry with a primary specialty of Optometrist in Kenmore, NY and a listed phone number of (716) 871-0074.
Source: public NPPES record, last updated May 27, 2015. This profile is informational and is not medical advice, a quality rating, or a provider recommendation.
Profile Overview
- NPI
- 1861885451
- Provider Type
- Organization
- Primary Specialty
- Optometrist
- Enumeration Date
- March 06, 2015
- Last Updated
- May 27, 2015
Practice Location
- 978 Colvin Blvd
- Kenmore, NY 14217-2128
Phone: (716) 871-0074
Authorized Official
- Name
- Dr. Mark Jay Gordon
- Title
- Owner
- Credentials
- OD
- Phone
- (716) 871-0074
Specialties
- Optometrist (152W00000X)
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Full Record
- NPI
- 1861885451
- Entity Type
- Organization
- EIN
- <UNAVAIL>
- Organization Name
- Developmental Optometrist PC
- 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) 878-8973
- 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) 878-8973
- Enumeration Date
- March 06, 2015
- Last Updated
- May 27, 2015
- Authorized Official Last Name
- Gordon
- Authorized Official First Name
- Mark
- Authorized Official Middle Name
- Jay
- Authorized Official Title
- Owner
- Authorized Official Phone
- (716) 871-0074
- Organization Subpart
- No
- Authorized Official Name Prefix Text
- Dr.
- Authorized Official Credential Text
- OD
- Taxonomy Group 1
- 193400000X Single Specialty Group
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Optometrist (152W00000X)