Provider Demographics
NPI:1700991114
Name:GOLD, JEFFREY (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
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 1:504 NEWPORT CIR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-2489
Mailing Address - Country:US
Mailing Address - Phone:215-355-6471
Mailing Address - Fax:
Practice Address - Street 1:225 BUSTLETON PIKE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6448
Practice Address - Country:US
Practice Address - Phone:215-355-1300
Practice Address - Fax:215-355-8745
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-000757152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0558984000OtherKEYSTONE HPE
PA119455TNBOtherNOVITAS SOLUTIONS
PA01301081Medicaid
PA5902TOtherVISION BENEFITS OF AMERIC
PA32276OtherDAVIS VISION
PA55779OtherAETNA HMO
PA3982183OtherAETNA HMO
PA171080OtherBUDD
PA000119455OtherIBX-HIGHMARK
PA32276OtherDAVIS VISION