Basic Information
| Provider Information | |||||||||
| NPI: | 1114106366 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADINA S. GOULD OD PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SOUTH FLORIDA OPTOMETRY | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6535 ALLISON RD. | ||||||||
| Address2: | |||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FLORIDA | ||||||||
| PostalCode: | 33141 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 7865869404 | ||||||||
| FaxNumber: | 3056950662 | ||||||||
| Practice Location | |||||||||
| Address1: | 4308 ALTON RD STE 910 | ||||||||
| Address2: | |||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331404560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7865869404 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2007 | ||||||||
| LastUpdateDate: | 08/25/2009 | ||||||||
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| AuthorizedOfficialLastName: | GOULD | ||||||||
| AuthorizedOfficialFirstName: | ADINA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7865869404 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC3743 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 620880100 | 05 | FL | MEDICAID |