MEDICARE: SAMUEL GOLD OD INC.

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	1671	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366879868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMUEL GOLD OD INC.

Provider Business Mailing Address
First Line	:	711 SHOTWELL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77020-4813
Country	:	US
Telephone Number	:	713-673-6550
Fax Number	:	713-673-6900

Provider Business Practice Location Address
First Line	:	711 SHOTWELL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77020-4813
Country	:	US
Telephone Number	:	713-673-6550
Fax Number	:	713-673-6900

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. SAMUEL GOLD
Credential	:	O. D.
Telephone Number	:	713-673-6550

Provider Enumeration Date	:	09/30/2013
Last Update Date	:	12/03/2015

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