MEDICARE: DR. BETTE L GOULD O.D.

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	66037T	CA

General Provider Information

NPI Number	:	1386604528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETTE L GOULD O.D.

Provider Business Mailing Address
First Line	:	210 MAIN STREET
Second Line	:	100
City	:	HALF MOON BAY
State	:	CA
Zip	:	94019
Country	:	US
Telephone Number	:	650-712-1234
Fax Number	:	650-726-5749

Provider Business Practice Location Address
First Line	:	210 MAIN ST
Second Line	:	100
City	:	HALF MOON BAY
State	:	CA
Zip	:	94019-1722
Country	:	US
Telephone Number	:	650-712-1234
Fax Number	:	650-726-5749

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/08/2007

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