MEDICARE: DR. MICHAEL BRIAN NOLEN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	560	NH

General Provider Information

NPI Number	:	1104915008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL BRIAN NOLEN O.D.

Provider Business Mailing Address
First Line	:	1500 S WILLOW ST
Second Line	:	SEARS OPTICAL
City	:	MANCHESTER
State	:	NH
Zip	:	03103-3220
Country	:	US
Telephone Number	:	603-624-8363
Fax Number	:	603-628-5266

Provider Business Practice Location Address
First Line	:	1500 S WILLOW ST
Second Line	:	SEARS OPTICAL
City	:	MANCHESTER
State	:	NH
Zip	:	03103-3220
Country	:	US
Telephone Number	:	603-624-8363
Fax Number	:	603-628-5266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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