Organization
MICHAEL D GORDON OD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL D GORDON OD (PRESIDENT)
(316) 684-2020
Entity
Organization
Contact information
Practice address
8100 E 22ND ST N, BLDG 1600, WICHITA, KS 67226
(316) 684-2020
(316) 686-7307
Mailing address
8100 E 22ND ST N, BLDG 1600, WICHITA, KS 67226
(316) 684-2020
(316) 686-7307
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
10462
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017087
BCBS
—
01
—
0254820002
CIGNA MEDICARE
—
Enumeration date
09/20/2006
Last updated
08/22/2020
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