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General NPI Number Information
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NPI Number | 1275683880
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Entity Type | Organization
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Legal Business Name | GOLD OPTOMETRY INC.
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 05/28/2015
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Provider Practice Location Address
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Address Line | 8901 GARDEN GROVE BLVD
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City | GARDEN GROVE
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State | CA
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Zip | 92844-1213
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Country | US
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Telephone | 714-530-1001
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Fax | 714-530-1289
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Provider Business Mailing Address
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Address Line | 8901 GARDEN GROVE BLVD
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City | GARDEN GROVE
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State | CA
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Zip | 92844-1213
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Country | US
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Telephone | 714-530-1001
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Fax | 714-530-1289
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHELLE H KIM
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Credential | O.D.
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Telephone | 213-248-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 12591T
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License Number State | CA
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