Provider Demographics
NPI:1679641062
Name:GORDON, MARC AARON (OD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:AARON
Last Name:GORDON
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:10219 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2331
Mailing Address - Country:US
Mailing Address - Phone:718-290-3566
Mailing Address - Fax:718-507-2729
Practice Address - Street 1:10219 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2331
Practice Address - Country:US
Practice Address - Phone:718-290-3566
Practice Address - Fax:718-507-2729
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2011-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOPC4132152W00000X
NYTUV007126-1152W00000X
NJ27OA00619000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist