Healthcare Provider Details

I. General information

NPI: 1346415106
Provider Name (Legal Business Name): DR. NELSON GOULD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 BLACK ROCK TPKE
FAIRFIELD CT
06825-3552
US

IV. Provider business mailing address

2060 BLACK ROCK TPKE
FAIRFIELD CT
06825-3552
US

V. Phone/Fax

Practice location:
  • Phone: 203-333-5590
  • Fax: 203-333-6722
Mailing address:
  • Phone: 203-333-5590
  • Fax: 203-333-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number933
License Number StateCT

VIII. Authorized Official

Name: DR. NELSON LEONARD GOULD
Title or Position: OWNER
Credential: O.D.
Phone: 203-333-5590