Provider Demographics
NPI:1841504180
Name:GOLD, JAMIE LINN (OD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LINN
Last Name:GOLD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 UPTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3507
Mailing Address - Country:US
Mailing Address - Phone:972-637-1300
Mailing Address - Fax:866-353-7586
Practice Address - Street 1:634 UPTOWN BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3507
Practice Address - Country:US
Practice Address - Phone:972-637-1300
Practice Address - Fax:866-353-7586
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7754TG152W00000X
MO2010020585152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1841504180Medicare PIN
TX8A3025Medicare UPIN
MO145450012Medicare PIN