Provider Demographics
NPI:1104238740
Name:GORDEYEVA, MARINA (OD)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:GORDEYEVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:DROZD GORDEYEVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:206 N MAIN RD # A
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-8201
Mailing Address - Country:US
Mailing Address - Phone:856-691-0720
Mailing Address - Fax:
Practice Address - Street 1:206 N MAIN RD
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-8201
Practice Address - Country:US
Practice Address - Phone:856-691-0720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00652500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist