Provider Demographics
NPI:1992770275
Name:GOULD, JEFFERY A (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:A
Last Name:GOULD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PSC 80 BOX 15701
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367-0060
Mailing Address - Country:US
Mailing Address - Phone:01181611-730-4039
Mailing Address - Fax:
Practice Address - Street 1:18TH MDG OPTOMETRY CLINIC
Practice Address - Street 2:UNIT 5267
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96368-5267
Practice Address - Country:US
Practice Address - Phone:01181611-730-4039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003872152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist