Provider Demographics
NPI:1114106366
Name:ADINA S. GOULD OD PA
Entity Type:Organization
Organization Name:ADINA S. GOULD OD PA
Other - Org Name:SOUTH FLORIDA OPTOMETRY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:786-586-9404
Mailing Address - Street 1:6535 ALLISON RD.
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FLORIDA
Mailing Address - Zip Code:33141
Mailing Address - Country:UM
Mailing Address - Phone:786-586-9404
Mailing Address - Fax:305-695-0662
Practice Address - Street 1:4308 ALTON RD STE 910
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4560
Practice Address - Country:US
Practice Address - Phone:786-586-9404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3743152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620880100Medicaid
FLU97702Medicare UPIN