Gordon, Timothy Eugene

Gordon, Timothy Eugene is an sole proprietor health care provider with primary practice located at 5701 Herrera Dr , Santa Fe NM 87507-2677. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Gordon, Timothy Eugene can be contacted via phone (505) 424-9139.

Contact Information

Primary practice address
5701 Herrera Dr Santa Fe NM 87507-2677
Fax: (505) 424-1384
Website:

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 2274 New Mexico

Profile Details

NPI number 1053324988
LBN Legal business name Gordon, Timothy Eugene
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 14th, 2006
Last updated Sep 27th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053324988 NPPES
New Mexico MEDICAID 000P4328

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