Provider Demographics
NPI:1316996150
Name:GOLD, GARY M (O D)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:M
Last Name:GOLD
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S SUNNYVALE AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-6249
Mailing Address - Country:US
Mailing Address - Phone:408-736-3802
Mailing Address - Fax:408-736-6354
Practice Address - Street 1:130 S SUNNYVALE AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-6249
Practice Address - Country:US
Practice Address - Phone:408-736-3802
Practice Address - Fax:408-736-6354
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6234152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6234OtherLICENSE
CAMG00641262OtherDEA
CA6234OtherLICENSE
CAT10271Medicare UPIN
CAMG00641262OtherDEA