Provider Demographics
NPI:1194733030
Name:GOLD, SAMUEL NMI (OD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:NMI
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 1:711 SHOTWELL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77020
Mailing Address - Country:US
Mailing Address - Phone:713-673-6550
Mailing Address - Fax:713-673-6900
Practice Address - Street 1:711 SHOTWELL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77020
Practice Address - Country:US
Practice Address - Phone:713-673-6550
Practice Address - Fax:713-673-6900
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1671152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T13487Medicare UPIN
TX00E56KMedicare ID - Type Unspecified