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General NPI Number Information
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NPI Number | 1942296983
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Entity Type | Individual
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Provider Name | DANA MARIE NOLAN OD
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Gender | Female
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 09/24/2012
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Provider Practice Location Address
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Address Line | 3588 SAINT JOHNS AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32205-8446
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Country | US
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Telephone | 904-388-7767
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Fax | 904-388-0067
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Provider Business Mailing Address
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Address Line | 3588 SAINT JOHNS AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32205-8446
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Country | US
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Telephone | 904-388-7767
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Fax | 904-388-0067
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPC003292
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License Number State | FL
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