Provider Demographics
NPI:1063523108
Name:BARBARA ANN GORDEUK OD LLC
Entity type:Organization
Organization Name:BARBARA ANN GORDEUK OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GORDEUK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-968-0203
Mailing Address - Street 1:4899 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:PIPERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18947-1151
Mailing Address - Country:US
Mailing Address - Phone:215-766-3997
Mailing Address - Fax:
Practice Address - Street 1:495 S OXFORD VALLEY RD
Practice Address - Street 2:
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-4202
Practice Address - Country:US
Practice Address - Phone:215-949-6611
Practice Address - Fax:215-949-6613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPA6881OtherEYEMED
PA36092OtherDAVIS VISION-WALMART
PA53028OtherDAVIS VISION-KEYSTONE
PA0192730000OtherINDEPENDENCE BLUE CROSS
PA57599OtherAETNA-US HEALTHCARE
PA01851714Medicaid
PA36092OtherDAVIS VISION-WALMART
PAPA6881OtherEYEMED