MEDICARE: DR. MARC BERNARD 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	3470 TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80112108	OTHER	TX	CONTROL SUB
2	G0440280	OTHER		US CON SUPT M

General Provider Information

NPI Number	:	1225040678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC BERNARD GOLD OD

Provider Business Mailing Address
First Line	:	711 SHOTWELL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77020-4813
Country	:	US
Telephone Number	:	713-644-2375
Fax Number	:	713-673-6900

Provider Business Practice Location Address
First Line	:	6328 TELEPHONE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-5410
Country	:	US
Telephone Number	:	713-644-2375
Fax Number	:	713-673-6900

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	01/18/2008

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