MEDICARE: JEFFREY H GOLD OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT8975T	CA

General Provider Information

NPI Number	:	1508139072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY H GOLD OD

Provider Business Mailing Address
First Line	:	5450 CLAIREMONT MESA BLVD
Second Line	:	STE D
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-2346
Country	:	US
Telephone Number	:	858-292-1700
Fax Number	:	858-292-1986

Provider Business Practice Location Address
First Line	:	5450 CLAIREMONT MESA BLVD
Second Line	:	STE D
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-2346
Country	:	US
Telephone Number	:	858-292-1700
Fax Number	:	858-292-1986

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY HOWARD GOLD
Credential	:	OD
Telephone Number	:	858-292-1700

Provider Enumeration Date	:	02/14/2012
Last Update Date	:	06/19/2012

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