Healthcare Provider Details

I. General information

NPI: 1942296983
Provider Name (Legal Business Name): DANA MARIE NOLAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3588 SAINT JOHNS AVE
JACKSONVILLE FL
32205-8446
US

IV. Provider business mailing address

3588 SAINT JOHNS AVE
JACKSONVILLE FL
32205-8446
US

V. Phone/Fax

Practice location:
  • Phone: 904-388-7767
  • Fax: 904-388-0067
Mailing address:
  • Phone: 904-388-7767
  • Fax: 904-388-0067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC003292
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: