Provider Demographics
NPI:1386604528
Name:GOULD, BETTE L (OD)
Entity type:Individual
Prefix:DR
First Name:BETTE
Middle Name:L
Last Name:GOULD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:210 MAIN STREET
Mailing Address - Street 2:100
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019
Mailing Address - Country:US
Mailing Address - Phone:650-712-1234
Mailing Address - Fax:650-726-5749
Practice Address - Street 1:210 MAIN ST
Practice Address - Street 2:100
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1722
Practice Address - Country:US
Practice Address - Phone:650-712-1234
Practice Address - Fax:650-726-5749
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA66037T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist