Healthcare Provider Details

I. General information

NPI: 1114106366
Provider Name (Legal Business Name): ADINA S. GOULD OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 ALTON RD STE 910
MIAMI BEACH FL
33140-4560
US

IV. Provider business mailing address

6535 ALLISON RD.
MIAMI BEACH FLORIDA
33141
UM

V. Phone/Fax

Practice location:
  • Phone: 786-586-9404
  • Fax:
Mailing address:
  • Phone: 786-586-9404
  • Fax: 305-695-0662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC3743
License Number StateFL

VIII. Authorized Official

Name: DR. ADINA S GOULD
Title or Position: PRESIDENT
Credential: OD
Phone: 786-586-9404