Provider Demographics
NPI:1770688939
Name:GOULD, LAWRENCE MARTIN SR (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:MARTIN
Last Name:GOULD
Suffix:SR
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-1022
Mailing Address - Country:US
Mailing Address - Phone:954-574-0885
Mailing Address - Fax:
Practice Address - Street 1:2000 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1022
Practice Address - Country:US
Practice Address - Phone:954-942-7717
Practice Address - Fax:954-942-2248
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1489156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0709620001Medicare NSC