Provider Demographics
NPI:1225040678
Name:GOLD, MARC BERNARD (OD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:BERNARD
Last Name:GOLD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:711 SHOTWELL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77020-4813
Mailing Address - Country:US
Mailing Address - Phone:713-644-2375
Mailing Address - Fax:713-673-6900
Practice Address - Street 1:6328 TELEPHONE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-5410
Practice Address - Country:US
Practice Address - Phone:713-644-2375
Practice Address - Fax:713-673-6900
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3470 TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80112108OtherCONTROL SUB
G0440280OtherUS CON SUPT M
T13488Medicare UPIN
G0440280OtherUS CON SUPT M
TX80112108OtherCONTROL SUB