Individual
DR. THEODORE BENNETT GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
354 SEWALL ST, CENTERGATE COMMONS, LUDLOW, MA 01056-2711
(413) 583-2260
(413) 583-3957
Mailing address
354 SEWALL ST, CENTERGATE COMMONS, LUDLOW, MA 01056-2711
(413) 583-2260
(413) 583-3957
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2253
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0306452
—
MA
Enumeration date
08/31/2005
Last updated
01/17/2008
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