Individual
DR. SCOTT DAVID GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
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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