Individual
DR. GORDON C GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
421 CHESTNUT ST, EVANSVILLE, IN 47713-1227
(812) 490-3937
(812) 426-9880
Mailing address
421 CHESTNUT ST, EVANSVILLE, IN 47713-1227
(812) 490-3937
(812) 426-9880
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003063B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11478959
CAQH PROVIDER ID
IN
Enumeration date
10/20/2005
Last updated
01/28/2016
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