Basic Information
| Provider Information | |||||||||
| NPI: | 1265448633 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLD | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 A4 ROCKVILLE PIKE | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019842111 | ||||||||
| FaxNumber: | 3019842193 | ||||||||
| Practice Location | |||||||||
| Address1: | 1950 OLD GALLOWS RD | ||||||||
| Address2: | SUITE 520 | ||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221823990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038478899 | ||||||||
| FaxNumber: | 7039911095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 12/17/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | TA0673 | MD | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 2200087 | 05 | MD | MEDICAID | 2200089 | 05 | MD | MEDICAID | 802348402 | 05 | MD | MEDICAID | 802348401 | 05 | MD | MEDICAID | 2200088 | 05 | MD | MEDICAID | 43765 | 01 | MD | DAVIS VISION | OTHER | 802348400 | 05 | MD | MEDICAID | 905876 | 05 | MD | MEDICAID |