Provider Demographics
NPI:1609875749
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/OWNER
Authorized Official - Prefix:DR
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 1:180 S STANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-2331
Mailing Address - Country:US
Mailing Address - Phone:937-335-9020
Mailing Address - Fax:937-335-6684
Practice Address - Street 1:180 S STANFIELD RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2331
Practice Address - Country:US
Practice Address - Phone:937-335-9020
Practice Address - Fax:937-335-6684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-0691G207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0800753OtherUNITED HEALTH CARE
OH2014680Medicaid
OH180028986OtherTROY RRMED
OH491600699004OtherMEDICAL MUTUAL, TROY
150957CROtherPREFERRED CARE
491600699-00OtherWORKERS COMP.
OH180028986OtherTROY RRMED
491600699-00OtherWORKERS COMP.
OH180028986OtherTROY RRMED