Basic Information
| Provider Information | |||||||||
| NPI: | 1538272455 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GORDON | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1716 UNIVERSITY BLVD | ||||||||
| Address2: | HPB G080A | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352940001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059344748 | ||||||||
| FaxNumber: | 2059346755 | ||||||||
| Practice Location | |||||||||
| Address1: | 1716 UNIVERSITY BLVD | ||||||||
| Address2: | HPB G080A | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352940001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059344748 | ||||||||
| FaxNumber: | 2059346755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 06/02/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | S574TA039 | AL | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 02129061 | 05 | MS | MEDICAID | 000059870 | 05 | AL | MEDICAID | 410048451 | 01 | AL | MEDICARE RAIDROAD | OTHER | 1585971 | 05 | LA | MEDICAID | 51059822 | 01 | AL | BCBS OF ALABAMA | OTHER | P00280010 | 01 | MEDICARE RAILROAD | OTHER | T68916 | 01 | AL | VIVA | OTHER | 51059870 | 01 | AL | BCBS | OTHER |