MEDICARE: MR. LAWRENCE MARTIN GOULD SR. OPTICIAN

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	156FX1800X	Optician	1489	FL

General Provider Information

NPI Number	:	1770688939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAWRENCE MARTIN GOULD SR. OPTICIAN

Provider Business Mailing Address
First Line	:	2000 N FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-1022
Country	:	US
Telephone Number	:	954-574-0885
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 N FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-1022
Country	:	US
Telephone Number	:	954-942-7717
Fax Number	:	954-942-2248

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	03/03/2008

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