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General NPI Number Information
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NPI Number | 1780858464
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Entity Type | Organization
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Legal Business Name | J DEAN NOLAN OD INC
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 02/17/2012
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Provider Practice Location Address
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Address Line | 3414 NW CACHE RD STE E
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City | LAWTON
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State | OK
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Zip | 73505-3877
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Country | US
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Telephone | 580-353-2015
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Fax | 580-353-2022
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Provider Business Mailing Address
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Address Line | 3414 NW CACHE RD STE E
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City | LAWTON
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State | OK
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Zip | 73505-3877
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Country | US
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Telephone | 580-353-2015
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Fax | 580-353-2022
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEAN NOLAN
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Credential | OD
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Telephone | 580-353-2015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1091
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License Number State | OK
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