Individual
DR. SCOTT DAVID GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
225 E LEE AVE, YADKINVILLE, NC 27055
(336) 679-2931
(336) 677-6486
Mailing address
225 E LEE AVE, YADKINVILLE, NC 27055-8227
(336) 679-2931
(336) 677-6486
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1999
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598723934
NPI
—
01
—
1999
OD LICENSE
NC
01
—
2474038C
MEDICARE - YADKINVILLE
—
01
—
2474038D
MEDICARE - EAST BEND
—
01
—
525320
OE TRACKER
—
05
—
5908096
—
NC
Enumeration date
05/03/2006
Last updated
03/07/2023
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