| |
195 Roosevelt Trail, South Casco, ME 04077 | |
(207) 655-2020 | |
(207) 655-7770 |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 195 Roosevelt Trail, South Casco, Maine |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1265754519 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 760 (Maine) | Primary |
Provider Name | Thomas V Gordon |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1023181062 PECOS PAC ID: 0446294466 Enrollment ID: I20050610000486 |
Provider Name | Brenna Gerchman |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1518583319 PECOS PAC ID: 7618372160 Enrollment ID: I20210820001103 |
Mailing Address | Practice Location Address |
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Po Box 200, South Casco, ME 04077-0200 Ph: (207) 655-2020 | 195 Roosevelt Trail, South Casco, ME 04077 Ph: (207) 655-2020 |
Dr. Thomas Vincent Gordon, O.D. Optometrist Medicare: May Accept Medicare Assignments Practice Location: 195 Roosevelt Trail, South Casco, ME 04077 Phone: 207-655-2020 Fax: 207-655-7770 |