Individual
DR. LOUIS IRA GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
7810 WORMANS MILL RD, SUITE C, FREDERICK, MD 21701-3035
(301) 228-2666
(301) 228-2119
Mailing address
1950 OLD GALLOWS RD, SUITE 520, VIENNA, VA 22182-3990
(703) 847-8899
(703) 991-0514
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TA0647
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0923640001
DMERC A DME REGION A
MD
01
—
410031313
RAILROAD MEDICARE
MD
Enumeration date
06/30/2005
Last updated
12/03/2014
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