Provider Demographics
NPI:1104907575
Name:GORDON, STEVEN PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PAUL
Last Name:GORDON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26300 CEDAR RD STE 2005
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1185
Mailing Address - Country:US
Mailing Address - Phone:216-514-9777
Mailing Address - Fax:216-514-0942
Practice Address - Street 1:26300 CEDAR RD STE 2005
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-514-9777
Practice Address - Fax:216-514-0942
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5039152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2167695Medicaid
OH2167695Medicaid