Organization
DEVELOPMENTAL OPTOMETRIST PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK JAY GORDON OD (OWNER)
(716) 871-0074
Entity
Organization
Contact information
Practice address
978 COLVIN BLVD, KENMORE, NY 14217-2128
(716) 871-0074
(716) 878-8973
Mailing address
978 COLVIN BLVD, KENMORE, NY 14217-2128
(716) 871-0074
(716) 878-8973
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV004506
NY
Other
Enumeration date
03/06/2015
Last updated
05/27/2015
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