Provider Demographics
NPI:1184163776
Name:GOLD, CINDY JOAN
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:JOAN
Last Name:GOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 PORTLAND AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-2731
Mailing Address - Country:US
Mailing Address - Phone:585-544-3430
Mailing Address - Fax:585-544-3473
Practice Address - Street 1:1295 PORTLAND AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2731
Practice Address - Country:US
Practice Address - Phone:585-544-3430
Practice Address - Fax:585-544-3473
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008789-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician