1881726305 NPI number — R. GRIFF GORDY PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881726305 NPI number — R. GRIFF GORDY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R. GRIFF GORDY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GORDY EYECARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881726305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1756 EDINBURGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRATTVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36066-3614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-303-6336
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5009 RIVER CHASE DR
Provider Second Line Business Practice Location Address:
BUILDING 100 SUITE B
Provider Business Practice Location Address City Name:
PHENIX CITY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36867-7425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-303-6336
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GORDY
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
GRIFFITH
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
334-303-6336

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  S-A51-TA-630 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)