Provider Demographics
NPI:1114994308
Name:FINGOLD, DOUGLAS R (OD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:R
Last Name:FINGOLD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 MARINA BAY DR STE A
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2480
Mailing Address - Country:US
Mailing Address - Phone:281-535-8876
Mailing Address - Fax:281-538-0366
Practice Address - Street 1:2700 MARINA BAY DR STE A
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2480
Practice Address - Country:US
Practice Address - Phone:281-535-8876
Practice Address - Fax:281-282-9885
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03270TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX76-0427499OtherSUPERIOR
TX81286QOtherBLUE CROSS BLUE SHIELD
TXTX3270OtherEYEMED
TX346113901Medicaid
TX760427499 0002OtherCIGNA
TX2814865043OtherVSP
TX9546OtherHUMANA
TX81286QOtherBLUE CROSS BLUE SHIELD
TX904270OtherBLOCK
TX07674OtherSPECTERA
TXTX3270OtherEYEMED
TX6293OtherAVESIS
TX9546OtherHUMANA