Provider Demographics
NPI:1336122373
Name:TODD GOULD MD INC
Entity Type:Organization
Organization Name:TODD GOULD MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-335-9020
Mailing Address - Street 1:821 NICKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-1739
Mailing Address - Country:US
Mailing Address - Phone:937-778-1812
Mailing Address - Fax:937-778-9114
Practice Address - Street 1:821 NICKLIN AVE
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356
Practice Address - Country:US
Practice Address - Phone:937-778-1812
Practice Address - Fax:937-778-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
35-07-0691G207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0800753OtherUNITED HEALTH CARE
150957CROtherPREFERRED CARE
000000012948OtherANTHEM
OH2014680Medicaid
491600699002OtherMEDICAL MUTUAL
180027332OtherRR MED
0800753OtherUNITED HEALTH CARE
491600699002OtherMEDICAL MUTUAL
150957CROtherPREFERRED CARE