MEDICARE: DR. BERNICE GOLL 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	OEG001775	PA

General Provider Information

NPI Number	:	1558417063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNICE GOLL OD

Provider Business Mailing Address
First Line	:	119 YORK RD
Second Line	:
City	:	JENKINTOWN
State	:	PA
Zip	:	19046-3248
Country	:	US
Telephone Number	:	215-884-8419
Fax Number	:	215-884-8127

Provider Business Practice Location Address
First Line	:	119 YORK RD
Second Line	:
City	:	JENKINTOWN
State	:	PA
Zip	:	19046-3248
Country	:	US
Telephone Number	:	215-884-8419
Fax Number	:	215-884-8127

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	12/31/2014

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