Provider Demographics
NPI:1396801544
Name:GOLD, JEFFREY H (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:H
Last Name:GOLD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1238 MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-2215
Mailing Address - Country:US
Mailing Address - Phone:619-448-7228
Mailing Address - Fax:
Practice Address - Street 1:1315 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-597-6987
Practice Address - Fax:719-597-7190
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 8975 TPA152W00000X
COOPT0003065152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP8975Medicare PIN
CAT90804Medicare UPIN