Provider Demographics
NPI:1508139072
Name:JEFFREY H GOLD OD
Entity Type:Organization
Organization Name:JEFFREY H GOLD OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:858-292-1700
Mailing Address - Street 1:5450 CLAIREMONT MESA BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-2346
Mailing Address - Country:US
Mailing Address - Phone:858-292-1700
Mailing Address - Fax:858-292-1986
Practice Address - Street 1:5450 CLAIREMONT MESA BLVD
Practice Address - Street 2:STE D
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-2346
Practice Address - Country:US
Practice Address - Phone:858-292-1700
Practice Address - Fax:858-292-1986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8975T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT90804Medicare UPIN
CAFY139AMedicare PIN